HIV stands for Human Immuno Deficiency Virus. It is an RNA virus belonging to the group of retro virus. It has the size of 1/10,000 th of a mm and can be seen only under the electron microscope. This means that a needle-point can include thousands of viruses. It has the shape of a curled up porcupine. It is a highly fragile organism and hence is easily killed outside the human body. Boiling for one minute in water and treatment with 1% bleach solution for 30 minutes will kill the virus. HIV has an outer capsule and an inner core containing an enzyme called reverse trasncriptase and two single strands of RNA - the generic material of the virus.

About two cores of people worldwide wrwe infected with HIV in 1994. It is estimated that the number of infected people will rise to 4 crores bt 2000 AD. More than 90% of these infected people will be in developing countries like India. Practically all states are affected. HIV spreads rapidly among people with high risk behaviour such as persons who have multiple sex parteners and injectable drug users whoshare unsterilised needles. WHO estimates that there could be 1-1.5 million peiple with HIV infection in India now.

HIV thrives and multiplies in the human body cells. It is present in all body fluids of an infected person such as blood, semen, vaginal secreations etc. Hence those secretions can be a source of infection. HIV can pass through the blood brain barrier and infect brain, cells. Though there is evidence of presence of HIV in saliva, tear, sweat and mothers milk, the concentration of HIV is so low in these secretions that these body fluids cannot be a source of infection.

The important point to remember is that once HIV enters the body of a person, that person become infectius to others in a span of 6 hours and remain infectious throughout his life.

After entering the body HIV first attacks T-4 lymphocytes which are responsible for the protection of the human body. The RNA of the virus which is converted into DNA unites with the host cells. In the cell it multiplies and buds out into a new virus which attacks other cells and destroys them. Slowly the T-4 cell count of the infected person drops to a level and the individual developes AIDS.

There are several theories regarding the origin of HIV/AIDS but so far there is no scientific explanation for any of them. It is possible that HIV has been around for centuries and may have evolved into a virulent virus by mutation recently.

An HIV infected person is one who has the HIV in his body. Such a person remains infectious for the rest of his life. However he will appear to be perfectly normal and healthy for many years. When the HIV positive person's immune status breaks down, he develops AIDS. AIDS is only the end stage of HIV infection.

Weeks after the virus enters the body, some people experience flu like symptoms, fever, headache and body ache. Generally it takes between 2-24 weeks to produce antibodies. During this period the HIV blood test for antibodies will be negative, though the person remains infectious. This period is known as "window period". Hence during the window period, it is not possible to detect whether a person has HIV.

The flu- like symptoms disappear after a while, usually without treatment even. This is followed by a long phase 0f 5-15 years which is asymptomatic and which normally goes undiagnosed. Throughout this period, the immune system starts failing gradually. The common infectious attacking HIV victims in India are TB, shingles (Herpes zoster), candidiasis, pneumonia, meningits, etc. These infections are called opportunistic infections.

It is the time from the start of the HIV infection to the development of symptoms of AIDS. This is usually 5 to 15 years depending on the immune status of the individual. Incubation period is different from window period.

There are a number of tests which can detect the HIV. These blood tests are based on detecting specific antibodies produced by the human body. One such is ELISA (Enzyme Linked Immuno Sorbent Assay). This is a screening test usually done in blood banks.

We have already learnt that "THE VIRUS IS PRESENT IN THE BLOOD AND BODY FLUIDS OF AN INFECTED PERSON". Therefore a mixing of one's blood or body fluids with that of an infected person can result in the transmission of the virus. The body fluids through which HIV may be transmitted are semen and the Vaginal/cervical fluid. All the other body fluids like tears, sweat, saliva, sputum, gastric juice, or other intestial juices do not contain enough of the virus to cause an infection. The Cerebrospinal fluid may transmit the virus only to a careless laboratory worker. Traces of the virus present in the breast milk can infect the baby through ulcers/abrasions in its mouth or throat.

This is the common mode of spresd all over the world and accounts for 80 to 90 % of all infected cases. HIV can be transmitted by sexual intercourse (Vaginal, Anal and Oral ) with an infected person. During such contact, HIV can enter a person's blood stream through the vagina, penis or anus. And transmission can occur man to woman, woman to man or from man to man. The efficiency of the transmission by a single sexual exposure is only 0.1 to 1 %. The risk of infection is greater if eithrt partner has another STD (Sexually Transmitted Diseas) like syphilis or herpes, where a sore or lesion is present. Semen or vaginal secretions of an HIV -infected person can come into contact with open sores or ulcers on or near the genitals of the partner and it is easier for the virus to pass into the other persons body. Although commercial sex workers run a higher risk of contracting the infection by the very nature of their profession, any person engaging in high risk behaviour like having sex with more than one partner is also at high risk of getting the infection.

Although the efficiency of transmission by a single transfusion is 90 %, it accounts for only about 10 % af all HIV infected persons. This is by receiving blood from a person infected with HIV. This could also occur by receiving organs or tissues that are HIV - infected. As such, teasting of blood for HIV before transfusion is mandatory. Every unit of blood has to be tested before transfusion and the government are striving hard to provide the facilities. Since we cannot predict the level of high risk behaviour in professional donors, the only way to ensure adequate supply of safe blood is by promoting voluntary blood donation on a large scale. Once people realize that blood donation is absolutely safe, more and more people will be coming forward to donate blood.

Although the efficiency of transmission by a single exposure is 0.1 to 1.0 % this accounts for about 10 % of all infected case. The highest incidence in India by this route is in Manipur. As IV drugs are very costly, it is the common practice among users to share a single unit among several. Also, they share the same syringe and needle. Before injecting the drug they make sure that the needle is correctly placed by withdrawing blood into the syringe. If one among them harbours the HIV, all the others share the same syringe at high risk.

This includes a host of procedures, which though commomly practised entail some degree of risk of HIV transmission. Inadequate sterilised needles of injection can convey the virus from a previous user to the next. It is particularly true in the case of quacks who have no idea of proper sterilisation techniques is a common sight in several of our villages. Unsterile instruments used in traditional circumsion, sacrification, tattooing, acupuncture and ear-piercing could very well transmit the virus. It is not safe to be shaved by a barber using an unsterile razor.

Although 25 to 30 % of all babies born to an HIV positive mother will be infected, this route accounts for only 0.1 % of all HIV infection. The virus might enter the baby's body through the placenta, or it may enter when the blood of the child and its mother get mixed at the time of child birth. In a small minority of cases virus in the breast milk may get in through an abrasion in the baby's mouth or throat.

A point to be emphasised is the fact that all the modes of transmission other than esxual, put together, forms only 20 % of all HIV infections. It must also be noted that HIV infection is not confined to any particular group, profession, religion, sex or national but is determined by the indulegence in high risk behaviour. UNSAFE SEX CONTACT WITH UNSAFE BLOOD.

HIV is not like other communicable diseases. It does not spread through ordinary casual contact. It is not airborne, water-borne, vector-borne nor is it spread by skin contact. It is transmitted only if a mixing of the blood or body fluid of an infected person take place with that of a noninfected person. It is spresd by:

HIV infection, therefore. It is not a public health nuisance like, say, TB, Leprosy, Common Cold, Jaundice, or Ringworm. To get infection one has to share infected blood or mix one's mix one's sexual fluids with that of an infected person through intimate contact.

No. For several reasons. a) Mosquitoes do not inject blood: they only suck it. b) Unlike in malaria/filariasis, where the organism has a life cycle inside the mosquito, HIV does not have any such cycle and so does not lodge in the salivary gland of the insect. c) Unlike a blood-contaminated needle the proboscis of the mosquito is kept perfectly clean always. d) the total quantity of blood ingested by a mosquito is so samll that it won't contain the infective dose of the virus. e) HIV predominantly affects young adults sparing the very young and the very old who should really have been more affected had mosquitoes been spreading the disease.

Most of the hospitals run by trained personnel and exercising reasonable precautions in sterilisation will not transmit the disease to the patients. However, those who visit quacks (unqualified persons) who have no idea of proper sterilisation methods can get the infection.

Theoretically yes, if we sustain a cut with a HIV infected blood-contaminated razor. Practically, No. The Chances of your visiting a barber whose previous client was HIV positive, the chances of the patient getting cut from the razor, the chances of the barber not cleaning the razor satisfactorily so as to leave infected blood on it, the chances of the barber's next client (youself) getting cut with the same razor, all these occuring together are so remote, practically non-existent.

As yet, there are no drugs available that can destroy the AIDS virus or restore the immune system once it is damaged. Nor do we have vaccine that can protect the body from HIV. So, until a vaccine or cure is found, the only weapon we have against AIDS, at present is KNOWLEDGE. AIDS is not curable but it totally preventable. Armed with the facts, anyone can protect oneself from AIDS. It is what we do, and not who we are, that puts us at risk.The virus is spread almost entirely through activities which we choose to purse or avoid. In the absence of a cure or a vaccine, education about AIDS is the solution to make individuals choose safe life-styles.

All the prventive and control measures against AIDS can be broadly divided into two levels: PREVENTION AT THE INDIVIDUAL LEVEL & PREVENTION AT THE COMMUNITY LEVEL.

As we have already learnt the modes of spread of virus, an individual should find it an easy task to avoid HIV infection. It can be prevented through relatively easy measures and precautions.

The majority of HIV infections throuhout the world. Has been acquired through sexual intercourse, mostly hetrosexual. The sexual transmission of HIV is dependent upon the type and frequency of sexual behaviour by individuals.

HIV is transmitted only through physical inoculation of blood or genital and other body secretions. The virus is transmitted by the penetrative sexual act in which HIV infected semen, vaginal or cervical secretions or blood is exchanged. Hence a change in behaviour from high risk to responsible sexual behaviour has become necessary. This is the esecense of safer sex. Safer sex does not simply mean using condom and reducing the number of sexual partners. It also means being able to express sexuality in ways that prevent transmission of HIV and other infections. It takes into account the complexity of human nature, while enabling individuals to have more control over their own sexual partnerships.

In the context of hetrisexual transmission ABSTINENCE (having no sex at all) is 100 % safe. But it is not a realistic alternative. Having sex with only one (uninfected) partner- MONOGAMY is usually very safe, provided it is lifelong. An agreement to be mutually faithful implies trust. Having only a single sexual partner(or completely avoiding premarital/extramarital sexual relations) is the safest first step in eliminating unsafe sex practices). If one has more than a single sexual partner, then the least one can do is to have safer sex through thr proper use of condoms.

Ignorance about the partner's life style or ignorance about AIDS can put one at high risk of getting the infection. Suppose person B is sexually faithful to person A. And suppose that person A also has sexual contact with three other persons and each of these three have sexual contact with three others, then person B can get infected through person A, if any one among the 13 harbours HIV. And note that person B has always been faithful. This emphasis the point that the lifestyle of one's partner can put one at high risk.

Some sexual practices carry greater risk of spreading HIV than others. Penetrative sex without condom which may cause local trauma or bleeding due to abrasions is more likely to transmit HIV sexually. It is essential that the barrier method in the form of condoms be used. Although condoms provide good protection, they can never be 100 % safe, because they can sometimes tear, break or slip off during sexual intercourse. But the risk are much less if used proferly, every single time, before the first genital contact.

STDs are those diseases which are transferred during sexual intercourse. Some of the commones are syphilis, gonorrhoea, herps, clamidia, etc. Some of the common symptoms are burning pain or urination, a discharge, sore, lump, ulcer or blisters on or near the sexual organs. Persons with STDs are at a much higher risk of getting infection because STD itself is a proof that they indulge in high risk sexual behaviour. More over a person with discharge has a 5 times greater efficiency of transmission of HIV with a single exposure while the risk is multiplied 20 times if there is an ulcer.

It is therefore essential that proper treatment for the STDs from a qualified dactor is taken to to effect a cure. It would also be very wise of the patient to bear in mind that he was very very lucky to have been let off with a treatable illness where as he could very well have contracted the dreaded AIDS at just the very same risk.

A lot has to be done to ensure that HIV is not transmitted through blood transfusion in the country. At the individual level it would be wise to remember that blood transfusion is risky and is to be avoided, if possible. But when it is really necessary, blood really saves a lot of lives. But then one should insist on screened HIV free blood. The Supreme Court has already given directives to ensure that only HIV freed blood is to transfused in the country even when blood is absolutely necessary, one should avoid blood from professional donors who may be living a high risk life. Choose blood from known voluntary donors with risk-free.

The fact that blood donation is very safe needs to be emphasised and widely publicized so that more and more voluntary donors come forward to meet the high demand. Then only can we ease out the more risky professional donor.

This is possible through ensuring the use of sterilised/disposable needles. Behaviour associated with IV Drug use is difficuilt to change. The sharing of needles and othet equipment is motivated partly by the addiction itself,(that is urge to immediately satisfy one's needs) and partly by the shortage of clean equipment. It is possible to spread the message 'CLEAN NEEDLE USE' among the drug users without in any way sanctioning the drug itself. Prostitution is a common source of income to several drug-users.

The risk of HIV infection in the work place is limited to medical and paramedical personnel, and lab technicians likely to handle infected materials. Strict compliance with instructions about universal precautions and barrier methods of patient care can almost elimate this mode of spread. The proper use of rubber gloves, masks, gowns and eye-wear and proper sterilisation of syringes and needles and the proper decontamination of all the instruments to be re-used can virtually eliminate hospital transmission of HIV.

One should never permit any invasive procedure to be carried out on one's body by quacks, or unqualified persons who do not follow proper sterilisation techniques. In common social practices where a mixing of blood is likely such as circumcision, earpiercing, tattooing, etc. Adoption of elementary such as sterilization of needles and other instruments will go a long way in preventing the spread of HIV.

Women who are infected will need special counselling and medical attention. Termination of pregnancy as an option should be discussed sensitively and the decision left to the mother. Women who are infected and considering pregency should be counselled and given all necessary facts so that they can take a decision on whether to have a baby or not. Women who are at a high risk of HIV infection have to be motivated to change to a risk-free lifestyle if they want to conceive.

Armed with scientific information, an all-out effort should be made to disseminate this information far and wide. Collective action at the community level should help modify the present high risk behaviour of the community to the risk-free lifestyle. As long as we do not have any cure or vaccine for AIDS, EDUCATION of every individual at risk is the only recourse against this killer-diseases. WE JUST HAVE TO REACH OUT INFORMATION TO THE PEOPLE BEFORE THE VIRUS OVERTAKES US TO ENGULG THEM.

In the previous section the routes through which a person can get infected were listed and explained. It was described that there are only three routes through HIV can enter a person.

If you take 100 people who are infected with HIV and look at the routes through which they became infected the following pattern will emerge.

Everyone would like to prevent an infection with HIV. It is easy to achieve protection against HIV. All that one has to do THINK AND ACT RATIONALLY. People get infected because they fail to think and act rationally. Let us see how we can do both.

This can happen only during pregnancy, delivery and rarely in the period of immediately after delivery. If a baby gets infected in this way it does not live beyond five years of age. In other words, anyone older than five years could never have got infected through this route. Is also means that as far as you are concerned, this route is non-exixtent.

We already saw that, if the blood of an HIV infected person enters the body of an uninfected person, the latter can get infected.Think about the situations in which blood from one person is likely to enter another person. You will find that such situations happen only during treatment in hospitals. Doctors and nurses are being trained to take proper precuations to avoid this happening. Thus doctors and nurses are working to prevent HIV entering your body through the blood route. This also means that you as an individual o not have to o anything in particular to avoid getting infected through the blood route.

As was mentioned before, about 90% of people get infected through this route. People have sex in privacy and others can do little to protect people having sex. So the only way is that people having sex should know how to protect themselves and act accordingly. To do this, first we have to find out what is the greatest source of danger that would lead a person to infection with HIV.

People sometime think that the greatest sources of danger are prostitutes or foreners. Think again. No one can normally have sex with you unless you also agree. Thus the greatest source of danger lurks within yourself. If you rease this, you can plan how to protect youself.

For this, you should realise that HIV infection is seen not only in prostitutes but also among the general public, rich and poor, young and old, educated and uneducated, men and women. Since people infected with HIV do not symptoms up to 5years or longer, you can not detect wether one is infected or not by looking at a person. A doctor also can not declare that a person is not infected even after detailed examination. Hence when you think rationally it is safer to assume that a person could be infected even if it is a person whom you know very well and looks healthy. Thus we find that though sex is necessary for humans, it carries considerable risk now unless you think and act rationally

If you learn and practise these methods you can lead a happy life free from the fear of getting HIV and consequently AIDS. To learn this you have to understand sex.

Sex gives pleasure. It is to be noted that people are usually much interested in sex. This applies not only to the youth but to adults also. Because it gives pleasure, people may indulge in sex, unmindful of the consequences. Young people alos may get opportunities to have sex. It may be with someone whom they know or with commercial sex workers. In both this situations there is a risk of getting infected with HIV. Though the desire to have sex may be strong, one should realise that it may mean death from AIDS. IFF ALL YOUNG PEOPLE THINK AND ACT IN THIS MANNER AND HAVE SEX ONLY AFTER MARRIEGE WITH THIER LIFE PARTNERS, THE FUTURE GENERATION WILL BE AIDS FREE. In this way you would not only remain free from aids, but will also have tremendous emotional satisfaction. However you might get in to difficult situations occasionally.

It is also important to know that HIV can be transmitted not only through sex between male and female but also through sex between same sex.