Sunday, April 24, 2016

Quick HIV primer

Advice - Mind, Body and Family, Apr '16
By Dr. Prasenjit Saha

For your concerns about HIV exposure, its prevention and treatment (in the Indian context). 

Reader queries

There is so much half information about HIV floating around. Can one have a simple list of the most important things that should not be done if one has to prevent HIV infection? And where does one go to find out if one has HIV?
Sameera, West Bengal

Dear Sameera

HIV or the human immunodeficiency virus is primarily transmitted through blood and sexual fluids (semen and vaginal fluids). So penetrative sex (especially vaginal and anal) without a condom; sharing of needles for medical purposes, tattooing, body piercing and injecting drugs; and transfusion of untested blood or blood products are a strict no-no!

If you want to get tested for HIV, the best option is to head to an Integrated Counselling and Treatment Centre (ICTC) in any government hospital. The HIV test will be preceded by a pre-test counselling and will be carried out only after you have understood the issues involved and consented to the test. After the test, there will be post-test counselling when the test result is shared with you – to help you decide on the next steps whether you test positive or negative for HIV. Confidentiality of the test results will be strictly maintained – unless you are incapacitated for some reason, you should be the first one to know your test result from the counsellor.

Just a note of caution – HIV tests are also carried out at private sector clinics and hospitals, but they may not follow standardized testing techniques and protocols. They will also be more expensive than government hospitals, where testing is free.

People say HIV has become a chronic manageable disease like diabetes and hypertension. What exactly does this mean?
Anonymous, Kolkata

Dear Anonymous

First, a matter of principle: A person is far more than what infections they have in their body. Therein lies the issue of HIV being a manageable disease. But how does this work out in practical terms?

If a person tests positive for HIV at an ICTC, post-test counselling helps them deal with feelings of shock, fear, denial, anger, depression and even vengeance. After all, no disease is welcome, especially one that can be fatal and has so much stigma and discrimination associated with it. The counselling helps the person come to terms with their new situation and informs them about the next steps that can be taken. The very first of these is registration with a government-approved antiretroviral treatment (ART) centre – the counsellor provides guidance for this process. One just needs a photocopy of the HIV test report for the registration (other relevant documents may be provided later).

At the ART centre, the person goes through further counselling and medical examination, screening for opportunistic infections, baseline investigations and CD4 count testing. Starting ART is dependent on criteria like CD4 count (a special blood test that signifies the level of immunity the person has) and clinical staging (the World Health Organization classifies HIV infection into four stages depending on the severity of the infection). Generally, the lower the CD4 count, the more severe the infection is. 

Once started, ART has to be taken lifelong and periodic or monthly ART centre visits to refill the medicine containers, clinical examinations and investigations also become regular companions. And yet, home-based care is of prime importance, and counselling the person concerned as well as their family members or other caregivers in this regard is an important pillar of HIV management. Do you see here the similarities with management of other diseases?

The medical side apart, there is also something called ‘positive living’. This means making positive choices – developing a positive outlook in life, eating well and eating right, avoiding addictions, practising safer sex and physical exercise go a long way to boost the confidence of a person living with HIV (note the emphasis).

It is time to bid adieu to stigma, discrimination and fear associated with HIV. Let us all take a stand and reiterate that the person is more important than the problem. Reassurance works like a miracle for the persons infected or affected. Trust me!

Please click here to learn about prevention of mother to child transmission of HIV, and concerns around an HIV positive woman breastfeeding her child – Editor.

Since this article was published, the guidelines for starting ART have been revised in India. According to an office memorandum issued by the National AIDS Control Organisation, Ministry of Health & Family Welfare, Government of India on May 5, 2017, starting ART will no longer be dependent on CD4 count and other criteria like clinical stage of HIV infection, age and population. All people who test positive for HIV will be treated with ART at the earliest – Editor.

Dr. Prasenjit Saha is a public health professional working for people in pain. Write in your queries on the mind, body and family to, and we will be happy to answer them in consultation with the author – with due respect to confidentiality.

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