1.What is HIV? What is AIDS?

HIV (Human Immunodeficiency Virus) is a virus. You may hear that someone is HIV infected, or has HIV infection. These are terms that mean that the HIV was detected in their blood. If adequate care is not taken than they can pass the virus to other people.

HIV attacks the body's immune system. The immune system protects the body from infections and disease. ,but has no clear way to protect itself from HIV.Without treatment, most people infected with HIV are less able to fight off germs that we are exposed to everyday., Many of these germs do not usually make a healthy person sick,but they can cause life-threatening infections and cancers.in a person whose immune system has been weakened by HIV. Treatment for HIV can slow this process and allow people with HIV to live longer, healthier lives

People infected with HIV may have no symptoms for ten or more years. They may not know they are infected. An HIV test (blood test discussed below) is the only way to find out if you have HIV.

AIDS stands for Acquired Immune Deficiency Syndrome. It is a late stage of HIV infection

 A person with HIV infection has AIDS when he or she:

·        Has a CD4 cell count (a way to measure the strength of the immune system) that falls below 200. A normal CD4 cell count is 500 or higher. OR

·        Develops any of the specific  serious conditions - also called AIDS-defining illnesses - that are linked with HIV infection

 2. Who is at risk of being infected with HIV?

 A person of any age, sex, race, ethnic group, religion, economic background, or sexual orientation can get HIV. Those who are most at risk are:

·        People who have "unprotected sex" with someone who has HIV. Unprotected sex means vaginal, anal, or oral sex without using a condom.

·        People who share needles, syringes, or other equipment to inject drugs, with someone who has HIV.

·        Babies can potentially become infected during their mothers' pregnancy, during delivery, or after birth in the immediate post-partum period. They can also become infected through breastfeeding.

·        Health care  workers who at their workplace are  exposed to blood and/or body fluids, are at risk of getting infected with HIV. through occupational exposures like needle-stick injuries etc..

·         One can get infected with HIV,only if infected blood ,semen,vaginal fluids or breast milk gets into our body(blood

 3. How long can people live with HIV or AIDS?

Medicines that fight HIV have helped many people with HIV and AIDS live years and even decades longer than was possible in the past, before effective treatment was available. HIV treatments are not a cure, and they do not work equally well for everyone, but they have extended the lives of many people with HIV and AIDS. Without treatment, some people live for just a few years after getting HIV. Others live much longer.

4. Can I get a vaccine to prevent HIV infection or AIDS?

No. There is no vaccine to prevent HIV infection. Researchers are working to develop a vaccine. Vaccines in development are being tested to find out if they work.

5. Is there a cure for HIV or AIDS?

No. There is no cure for HIV or AIDS. However, there are medicines that fight HIV and help people with HIV and AIDS live longer, healthier lives.although they are still infected with HIV and can pass the virus to others.

6. How is HIV spread from one person to another?

HIV is spread when infected blood, semen, vaginal fluids, or breast milk gets into the bloodstream of another person through:

·        Direct entry into a blood vessel;

·         mucous linings, such as the vagina, rectum, penis, mouth, eyes, or nose; or

·        A break in the skin.

HIV is spread in the following ways:

·        Having vaginal, anal, or oral sex without using a condom.

·        Sharing needles, syringes, or works to inject drugs,

·        Women with HIV infection can pass HIV to their babies during pregnancy, delivery, and breastfeeding.

·        People who are exposed to blood and/or body fluids at work, like health care workers, may be exposed to HIV through needle-sticks or other occupational exposures.

·        It is also possible to pass HIV through sharing needles for piercing or tattooing . A person infected with HIV can pass the virus to others during these activities.

This is true even if the person:

·         Has no symptoms of HIV;

·        Has not been diagnosed with HIV/AIDS;

·        Is taking HIV medicine; or

·        Has an undetectable viral load

·         HIV is not spread by casual contact like sneezing, coughing, eating or drinking from common utensils, shaking hands, hugging, or using restrooms, drinking fountains, swimming pools, or hot tubs

7. Is it easy to get HIV?

No. HIV is not like the flu or a cold. It is not passed through casual contact or by being near a person who is infected. You can only get HIV if infected blood, semen, vaginal fluids, or breast milk gets into your body

8.How is HIV spread during injection drug use?

Small amounts of blood from a person infected with HIV may stay in the needles, syringes, or drug "works" (spoons, bottle caps, and cotton) and can be injected into the bloodstream of the next person who uses the same equipment without cleaning it properly. Any time you share injection equipment with someone who has HIV or whose HIV status you do not know; there is a high risk that you will get HIV.

9. How is HIV spread during anal sex?

Unprotected anal sex with a person who has HIV or whose HIV status you do not know is the highest-risk sexual activity for both men and women. The walls of the anus and rectum are thin and have many blood vessels that can be injured during anal sex. HIV-infected semen can be easily absorbed through these thin walls and into the bloodstream. Injured tissue in the anus and rectum can expose the penis to blood containing HIV. Using latex condoms for anal sex lowers HIV risk, but condoms fail more often during anal sex than during vaginal or oral sex. So, protected anal sex is still riskier than protected vaginal or oral sex

10. How is HIV spread during vaginal sex?

HIV is spread during vaginal sex when HIV-infected semen, vaginal fluid, or menstrual blood comes into contact with the mucous membranes of the vagina or penis. In general, since there is more mucous membrane area in the vagina, and a greater possibility of small cuts in the vagina, women are more likely than men to get infected with HIV through unprotected vaginal sex. Teenagers and women entering menopause are at especially high risk for getting HIV (and other sexually transmitted infections) because the tissue lining the vagina is more fragile at these ages. Cuts or sores on the penis or vagina raise the risk of HIV infection during vaginal sex for both men and women. Using a male latex condom or a female condom lowers your risk of getting HIV through vaginal sex

11. How is HIV spread during oral sex?

Although oral sex is less risky than anal or vaginal sex, it is possible to get HIV by performing oral sex with a HIV-infected partner. HIV transmission could potentially occur if blood, pre-ejaculation fluid, semen, or vaginal fluids enter open sores or cuts in or around the mouth, such as those caused by canker sores or blisters, vigorous teeth brushing or flossing, or some form of trauma. Using a latex barrier, like a condom or dental dam, reduces the risk of HIV infection.

12. Does having a sexually Transmitted Infection (STI) affect the risk of getting HIV? 

Yes. Having an STI, especially herpes or syphilis sores, increases risk of getting HIV and giving HIV to a partner. Many STIs do not cause symptoms, especially in women. It is important for sexually active men and women to get tested for STIs regularly, even if they have no symptoms.

13. Does sexual contact with many partners increase the risk of getting HIV? 

Yes. Having unprotected sex with many partners increases the risk of getting HIV because it increases the chances of coming into contact with someone who has HIV. It also increases the risk of getting other sexually transmitted infections (like herpes, gonorrhea, chlamydia, venereal warts, or syphilis).Having an STI, in turn, can make one more likely to get HIV.

 However, having unprotected sex with anyone who has HIV, or whose HIV status you do not know, puts one at risk. Hence, a person who has unprotected sex with just one partner can still get HIV if that partner was infected prior to having sex or becomes infected during the relationship.

14. Are women who have sex with women at risk for HIV infection? 

Woman-to-woman sexual transmission of HIV is rare, but it is possible. Women who have sex with women are at risk for HIV infection if they share needles to inject drugs or if they have unprotected sexual contact that results in blood-to-blood exposure. Women who have sex with women can reduce their risk of getting HIV by:

·         Not injecting drugs, or by not sharing needles, syringes, or works if they do use drugs and

·         Using a dental dam (a thin, square piece of latex), a non-lubricated condom that is cut open, or a plastic wrap as a barrier during oral sex. HIV transmission could potentially occur if vaginal secretions or menstrual blood enters open sores or cuts in or around the mouth, such as those caused by canker sores or blisters, vigorous teeth brushing or flossing, or some form of trauma. This could allow for the exchange of potentially infected blood or body fluids.

15. Can a woman who has HIV pass the virus to her baby?

Yes. A woman who has HIV can pass the virus to her baby during:

·         Pregnancy;

·         Delivery; or

·         Breastfeeding.

It is best for women to know their HIV status before they become pregnant or very early in their pregnancy so that they can make informed decisions which will help them reduce the risk of HIV transmission to the baby.

. 16. Can a person with HIV who is not sick or who has no symptoms pass HIV to someone else? 

Yes. Any person infected with HIV, even if he or she has no symptoms, can pass HIV to another person. Risk reduction measures need to be taken

17. Can a person with HIV who has an undetectable viral load pass HIV to someone else?

 Yes. A viral load test measures the amount of HIV in a person's blood. An undetectable viral load means that the amount of virus in a person's blood is too low for the test to measure. It does not mean that there is no HIV in the person's body. A person who has a low or undetectable viral load can pass HIV to someone else, although the risk is probably lower than if he or she had a high viral load. Risk reduction measures, like using condoms and not sharing needles,still  need to be taken

18.Can I get HIV from kissing? 

No one has ever gotten HIV through casual kissing, such as between parents and children. It is possible, but extremely unlikely, for HIV to be passed during "deep kissing.", HIV is not passed through saliva, but rather through direct blood-to-blood contact. like in the presence of gum disease

19. Can I get HIV from a human bite? 

It is very unlikely that a person would get HIV from a human bite. HIV can only be passed in this manner through direct blood-to-blood contact and not by exchanging saliva. To pass the virus, the infected person would need to have blood in his or her mouth and break the skin of the other person. The break in the skin of the uninfected person could allow infected blood to enter his or her bloodstream. If a person who does not have HIV bites and breaks the skin of a person with HIV, transmission of the virus could only occur if the uninfected person has open sores or cuts in the mouth that allow for blood-to-blood contact.

20. Can one get HIV from a mosquito bite? 

No. Studies have shown that mosquitoes and other insects do not pass HIV to humans. When an insect bites a person, it does not inject its own blood or a previous victim's blood into the new victim. It injects only saliva. Unlike the germs that cause malaria and other diseases spread by insect bites, HIV does not reproduce (and therefore cannot survive) in insects. So, even if the virus enters a mosquito or another sucking or biting insect, the insect does not become infected and cannot pass HIV to the next human that it feeds on or bites.

21 .Can I get HIV from living in the same house as a person with HIV or AIDS? 

There have been no reported cases of HIV transmission from casual contact while living with a person with HIV or AIDS, even for a long time. However, there have been reported cases where household members became infected with HIV as a result of direct blood-to-blood contact, such as sharing a razor or toothbrush, getting stuck with a needle, or by getting infected blood on a rash and/or open sore.

22 Can HIV be passed through food, water, or the air?

No. HIV is not passed through food, water, or air, or by touching any object that was handled by, touched by, or breathed on by a person who has HIV.

23 Can I get HIV from swimming pools or hot tubs?

No. HIV cannot survive in a hot tub or swimming pool. There have been no cases of HIV transmission through swimming pools or hot tubs.

24. Can I get HIV from body piercing, ear piercing, or tattoo needles?

HIV transmission from body piercing or tattooing is possible if the blood of a HIV infected person is left on a needle and the same needle is used to pierce or tattoo another person. To guard against this possibility, all needles and equipment used for piercing and tattooing should be new or should be sterilized between uses, and new ink should be used for tattooing. Moreover, other blood-borne illnesses such as hepatitis B and possibly hepatitis C, can be transmitted by sharing tattooing and piercing equipment.

25. What is being done to keep the blood supply and other blood products safe from HIV? 

All blood and organ donations are screened for HIV. In addition, all blood products, such as clotting factor, undergo heat treatment and at least one other process to kill HIV. Ensure that blood and blood products for transfusion be taken from licensed blood banks and check the labels for requisite information.

26. Are health care workers or people in other occupations at risk for HIV? 

Health care workers and others who are exposed to potentially infectious blood and/or other body fluids on the job are at risk. To reduce this risk, health care workers follow strict safety guidelines and use Universal Safety Precautions (USP) to prevent spreading disease. Universal Precautions include always wearing latex gloves when drawing blood or giving injections and washing hands before and after all procedures.

While these guidelines have reduced the frequency of on-the-job exposures (occupational exposure) to HIV, needle-sticks and other direct contact with blood and body fluids sometimes occur. In such situations medicines can be taken, after counseling and testing, to reduce the risk of HIV infection. This is called Post-Exposure Prophylaxis (PEP)

Post-Exposure Prophylaxis (PEP) - works best when it is started within a few hours, and no more than 36 hours, after HIV exposure. Although PEP can decrease the risk of HIV transmission to a person who has been exposed on the job, some people using PEP may still become infected with HIV. A health care worker who has a needle-stick injury or other direct contact with blood or body fluids should be evaluated right away to determine whether PEP is needed.

27 .Can I get HIV from contact with my doctor, dentist, or other health care professional?

It is extremely unlikely that you can get HIV or other blood-borne diseases from a doctor, dentist, or other health care professionals. To protect themselves and their patients, health care workers are required to use Universal Precautions to reduce the risk of exposure to blood or body fluids.

Dental health care providers should use latex gloves whenever they place their fingers in or around a patient's mouth. All medical personnel should use Universal Precautions with all patients. Patients can ask their health care providers about how Universal Precautions are followed where they receive their care.

28. Is there a test for HIV infection? 

Yes. There are a number of tests that detect either antibodies to HIV or HIV itself. Your body produces antibodies to fight germs. People who are infected with HIV have HIV antibodies in their blood. For adults and children age 18 months or older, 3 different types of HIV antibody tests are more than 99% accurate in determining whether a person is infected.

HIV antibody tests do not measure the amount of virus in the bloodstream. The tests also cannot tell if a person has AIDS, which is a late stage of HIV disease Other tests measure HIV directly rather than measuring antibodies to the virus. These tests are usually used to measure the amount of HIV in the bloodstream of someone who has already had a positive HIV antibody test. In some special situations (for example, to test newborn babies of HIV-infected women), tests that measure HIV directly are used to detect HIV infection. However, the HIV antibody test is by far the most common test for HIV infection.

29. Who needs to get tested for HIV? 

Everyone should know his or her HIV status. It is important for women who are pregnant or considering pregnancy to be tested. In addition, individuals who are at greater risk for HIV and who should be tested are those who:

·         Have had unprotected anal, oral, or vaginal sex;

·         Have shared needles, syringes, or works used to inject drugs,or other substances;

·        have ever had a sexually transmitted disease (chlamydia, syphilis, gonorrhea, herpes, genital warts);

·         Have had many sex partners;

·        Work in health care or other occupations where they may be exposed to HIV on the job ; or

·        Are victims of sexual assault.

30. How do I get tested for HIV? 

There are several different HIV testing options. Anonymous HIV antibody testing is available at VCTCs (Voluntary Counseling and Testing Centers) in all government and municipal hospitals provided at a nominal cost of Rs.10. HIV testing is voluntary and confidential. When you go for an HIV test you will first receive pre-test counseling. A counselor, doctor, or other health care provider will review your HIV risk and discuss your testing options.. You will need to give written consent for the HIV test.

31 .Should you wait for symptoms to appear before getting tested? 

No. If you think that you may have been exposed to HIV, you should get tested as soon as possible. You may have HIV and have no symptoms for many years. The sooner that HIV infection is detected, the sooner medical care can begin, which helps people with HIV stay healthier and live longer. In most cases, the immune system will stay healthier for a longer period of time if treatment starts before a person has symptoms.

32.How soon after exposure can HIV infection be detected?

With the HIV antibody tests used, virtually all people who are infected will test positive within one month of being infected. Most people will test positive even sooner.

The period between the time of infection and the time that a HIV antibody test can detect the infection is called the window period. During the window period, an infected person does have HIV and can pass HIV to other people, even if his or her HIV antibody test is negative.

If your HIV antibody test is negative, you can be sure that you do not have HIV only if you have not engaged in any HIV risk behaviors (such as having unprotected sex or sharing needles) during the past three months

A PCR (Polymerase Chain Reaction) test looks for HIV directly instead of detecting antibodies. This test can find HIV infection as soon as the person is infected. It is usually used to find HIV infection in newborns.

A different type of PCR test, called a viral load test, is used to measure the amount of HIV in the blood of someone who is already known to be infected.

Doctors may suggest an HIV PCR test if they think a person has been infected with HIV in the past few days or weeks

33.Why is it recommended that all pregnant women have an HIV test? 

HIV can be passed from mother to child during pregnancy, labor, delivery, and breastfeeding However, there are medicines and other options that can reduce this risk. Because it is important for pregnant women to know their HIV status, HIV counseling and testing is provided to all pregnant women in PPTCT centres (Prevention of Parent to Child Transmission of HIV)in public hospitals and maternity homes. Ideally, women should know their HIV status before considering pregnancy.

34. Is there a 100% effective way to prevent sexual transmission of HIV? 

The only 100% effective way to prevent sexual transmission of HIV is through abstinence - avoiding all vaginal, anal, and oral sex. Using a latex male condom or a female condom can greatly reduce, but not entirely eliminate, the risk of HIV transmission However; abstinence is the only method to completely eliminate the possibility of sexual transmission of HIV.

35 .Does using condoms reduce my risk of HIV infection? 

Yes. Using a latex male condom during vaginal, anal, or oral sex greatly reduces the risk of HIV infection by reducing the chance of direct contact with another person's semen, blood, or vaginal fluids. However, condoms do not provide 100 % protection against HIV infection. The main reasons that condoms sometimes fail are inconsistent or incorrect use:

·        Consistent use means using a new condom every time you have sex. Never reuse a condom.

·        Correct use includes putting the condom on and taking it off correctly and using a water-based lubricant (like glycerin, K-Y jelly) with the condom to prevent breakage. Oil-based lubricants such as petroleum jelly (Vaseline), cold cream, hand lotion, or baby oil can weaken the condom, causing it to break.

For people who are allergic to latex, male condoms made of polyurethane are available. Polyurethane condoms can help reduce the risk of getting HIV during sex, but it is not known whether they are as effective as latex condoms. Female condoms are also made out of polyurethane.

The protection provided by condoms is affected by how you store them, how carefully you open the package and put them on, correct usage, quality control by the manufacturer, and other factors. In general, condoms break or slip off more often during anal sex than during vaginal or oral sex.

36. What is the correct way to use a condom? 

·        Store condoms in a cool place, out of direct sunlight. Check the expiration date on the condom wrapper or box. Condoms that are past their expiration date may break. 

·         Open the package carefully. Teeth or fingernails can rip the condom. For latex male condoms: o Put on the condom after the penis is hard. If the penis is not circumcised, pull back the foreskin before putting on the condom. 

·        Pinch the tip of the condom to leave a little space (about a half inch) at the top to catch semen. Unroll the condom all the way down the penis. Add a little bit of water-based lubricant (like glycerin, K-Y®, )  to the outside of the condom. 

·        After ejaculation, hold the rim of the condom and pull out the penis while it is still hard, so that no semen spills out.

·         Use a new condom every time you have vaginal, anal, or oral sex.

For female condoms:

·        Insert the female condom before you have any sexual contact. 

·        Hold the female condom with the open end hanging down. Holding the outside of the condom, squeeze the inner ring with your thumb and middle finger. Put your index finger between your thumb and middle finger.

·        Still squeezing the inner ring, insert the condom into the vagina as far as it will go.

·        The inner ring holds the condom in place. The outer ring should be outside the vagina. Make sure the condom is not twisted. 

·         During sex, the condom may move from side to side or up and down. As long as the penis is covered, this is all right. If the penis enters under or outside the condom, stop right away. If the outer ring gets pulled into the vagina, stop right away. Take out the condom and reinsert it. 

·        After sex, just twist the outer ring to keep semen inside the condom and pull it out gently. 

·        Use a new condom every time you have sex.

37. Do male and female condoms provide the same protection against HIV?

There is not enough information to conclude whether or not the female condom is as effective as the male condom. Therefore, the latex male condom is still the best choice to protect against HIV.

If a latex male condom cannot be used, a female condom is the next best choice for protection. Studies show that female condoms are very effective in protecting against HIV. Male and female condoms should not be used at the same time. Female condoms, like latex male condoms, are available in drug stores, public hospitals, community health centers, and AIDS service organizations.

38.Do birth control methods other than condoms reduce the risk of HIV infection? 

No. Only condoms reduce the risk of both pregnancy and HIV infection. Birth control pills, the birth control patch, Norplant, Depo-Provera, intrauterine devices (IUDs), diaphragms, and any birth control methods other than condoms do not provide protection against HIV. One should use a latex male condom or a female condom for HIV prevention along with any other method used to prevent pregnancy.

39 .How can I prevent HIV transmission during oral sex? 

The risk of HIV transmission through oral sex is low, but people have been infected this way. Oral sex can be made safer by using a latex barrier. For oral sex performed on a man, a non-lubricated condom is recommended. For oral sex performed on a woman, a dental dam (a thin square of latex), a non-lubricated condom that is cudental cut open, or a plastic wrap can be used to cover the vagina. Oral-anal sex (rimming) is a high-risk activity that may be made safer by using a dental dam.

40.Does douching after sex reduce the risk of HIV infection? 

No. Douching after sex does not provide protection against HIV transmission because semen enters the cervical canal almost immediately after ejaculation. There is also no evidence that douching after anal sex offers any HIV protection. Douching can irritate vaginal tissues and make it easier to become infected by sexually transmitted infection (STIs) and HIV. It can cause infection by disrupting the natural balance of bacteria and yeast in the vagina and it can actually complicate an existing infection.

41. Do sex partners who both have HIV need to use condoms?

Yes. People who have HIV still need protection from sexually transmitted infection (STIs) and may want to prevent pregnancy. Condoms also protect against exposure to different types, or strains, of HIV. Re-infection or super-infection with a new strain of HIV may make the disease progress more quickly and may require the use of medicines different from the ones used to treat the original strain.

42.How can a pregnant woman with HIV prevent transmission of the virus to her infant? 

A pregnant woman who has HIV can take medicines that can lower the risk of her baby being born with HIV to less than 1 chance in 12. If the mother does not take these medicines, the baby has a 1 in 4 chance of being born with HIV. To get the most benefit from these medicines:

·        Pregnant women with HIV should talk to their doctor as early as possible in the pregnancy

·        Pregnant women with HIV should take a medicine while in labor and delivery, and therefore should plan, with their doctor, to come to the hospital early in labor so that there is enough time to take medicine before the baby is born.

·        The baby of a woman with HIV should start taking medicine right after birth, whether or not the mother took HIV medicines.

In scientific studies, when some women with HIV had a C-section (cesarean section) before labor started, the chance of passing HIV to their babies was reduced by one half. HIV can also be passed through breast milk. Replacement feeding is advised if acceptable, feasible affordable sustainable and safe. If, not, exclusive breast-feeding with early cessation (Cessation at or before 6 months) is recommended. Mixed feeding is not recommended. Infants given replacement foods and breast milk during the first 6 months are more likely to get HIV through breast milk than are those who are exclusively breastfed.

43. How can people who inject drugs reduce their risk of HIV infection?

Stop using drugs. The risk of becoming infected with HIV from needles and syringes can be completely eliminated by not injecting drugs.

Methadone maintenance is the most effective treatment program for heroin users. Studies have shown that heroin users who are in a methadone maintenance program are up to six times less likely to get HIV than users who are not in a program. Reduce injection drug use.

If it is not possible to stop using drugs, reducing the frequency of injection can reduce the number of potential exposures to HIV. A methadone maintenance program can help heroin users stop or reduce their drug use.

Always use new needles, syringes, and works. Don't share. HIV can be passed through infected blood in shared needles, syringes, spoons, bottle caps, cotton, and any other equipment used to inject. Using new needles and syringes to inject drugs can reduce the risk of transmitting HIV. However, syringes, needles, and works sold on the street as "new" may actually be used. They can transmit HIV if someone with HIV previously used them. Clean needles and works with bleach.

If you cannot get new, sterile syringes, you can reduce the risk of infection by always cleaning injection equipment (needles and works) immediately after use and just before reuse. This does not entirely eliminate HIV transmission risk, but it does reduce it

44.How should needles and syringes be cleaned? 

Step 1. Rinse with water to remove blood from syringe/needle. 

·        Pour clean water into clean cup or bottle cap.

·        Pull back on plunger and fill halfway with clean water.

·        Shake syringe/needle and squirt water out through the syringe/needle. 

·        Repeat this at least twice with new water or until all the blood and drug residue is gone. 

Step 2. Rinse with full strength bleach. o Pour full strength bleach (do not add water) into clean cup or bottle cap. 

·        Pull back on plunger and fill the syringe halfway with bleach. 

·        Shake syringe/needle and squirt bleach out through the syringe/needle. 

·        Repeat steps. 

Step 3. Rinse syringe/needle with clean water three more times. 

·        Before injecting, always rinse syringe/needle with water to remove the bleach. 

·        Keep the rinse water apart from water used to clean the syringe/needle and to prepare drugs. 

Things to remember: 

·        Do not reuse the cotton, water, bleach, or cooker. If the cooker must be reused, rinse it in bleach and then water. 

·        Store bleach in a container that is opaque (you can't see through it). Bleach loses its effectiveness with exposure to light. Label the container "bleach." 

·        Never assume that a syringe purchased on the street is new, even if it seems to be packaged as new. The easiest place to get new syringes is at the drugstore

45.Does using alcohol or other non-injected drugs increase my risk of HIV infection? 

Yes. Using non-injected drugs like alcohol, marijuana, crystal methamphetamine, ecstasy, or crack reduces your ability to make good decisions about safe sex and using clean needles and works. If you are drunk or high, you are less likely to think about protecting yourself and others from HIV. People who are addicted to drugs may also trade sex for money or drugs, which further increases their HIV risk. Evidence shows that treatment programs for any kind of substance use can reduce high-risk sex and drug-using behavior.

46. What are the symptoms of HIV infection? 

Shortly after being infected with HIV, some people - but not all people - have flu-like symptoms (fever, muscle aches, feeling tired) that last a few days and then go away. This is sometimes called seroconversion illness or acute HIV infection. Most people with HIV have no symptoms for many years. However, even without symptoms, people who are newly infected have large amounts of HIV circulating in their blood and are highly infectious at that time. HIV infection cannot be diagnosed from symptoms alone. The symptoms of worsening HIV infection and AIDS - swollen glands, fever, and skin rashes - can also be caused by other illnesses, many of which are more common than HIV infection. Only an HIV test can show whether a person has HIV 

47. When does a person with HIV infection have AIDS?

A person with HIV infection has AIDS when:  the person's CD4 cell count,( a way to measure the strength of the immune system), falls below 200 (a normal CD4 cell count is 500 or higher); or  the person develops any of the specific serious conditions - also called AIDS defining illnesses - linked with HIV infection

48. Why is it important for people with HIV to get medical care?

People with HIV should seek early medical care so they can:

·        Find out about medicines that fight HIV; and

·        Receive care for HIV-related conditions.

Treatments that fight HIV help people with HIV live longer, healthier lives. Often, it is best to start treatment before symptoms appear. A doctor can do blood tests to find out how much HIV is in a person's body and how much damage the virus has done to the immune system. This information helps people with HIV and their doctors decide when to start treatment and how well treatment is working. Early medical care helps people with HIV take best advantage of treatments for HIV. Certain medicines can also prevent some opportunistic illnesses like PCP (Pneumocystis carinii pneumonia). Testing and treatment for other illnesses, like TB (tuberculosis) and STDs (sexually transmitted diseases), is also important. These illnesses are more common in people with HIV and can make HIV progress more quickly to AIDS.

49.Do women with HIV need special medical care? 

Yes. Some medical problems are more common in women with HIV. These include:

·        Cervical cancer. HIV-infected women also have high rates of HPV (human papillomavirus) infection, especially those types that lead to the development of cervical cancer. Treatment with antiretroviral drugs may be able to change the course of HPV infection, but this has not yet been proven.

·        Vaginal yeast infections, which may be more frequent and need longer treatment in women with HIV. Women with HIV should have yearly pelvic exams and PAP smears to look for cervical cancer. Women with HIV also need to know how to prevent pregnancy (if they do not wish to become pregnant) and how to prevent passing HIV to their babies if they do choose to get pregnant. They should talk to a doctor about family planning, including how birth control pills interact with some HIV medicines. It is especially important for pregnant women with HIV to get medical care, because there are medicines that women with HIV can take to greatly reduce the risk of their babies being born with HIV. Children with HIV infection also need medical care as early as possible.

50. Should people with HIV tell their doctor, dentist, physician assistant, nurse practitioner, and other health care providers? 

Yes. To provide the best medical care, health care providers need to know the HIV status of their patients. It is against the law for health care providers to deny care to people with HIV because of their HIV status. By law, health care providers must keep your HIV status confidential

51. What are CD4 cell counts and viral load tests? 

CD4 cells are part of the immune system. Over time, HIV kills CD4 cells, making the immune system weaker. A person's CD4 cell count shows the strength or weakness of the immune system. Viral load is the amount of HIV in a person's blood. Over time, without treatment, the viral load of a person living with HIV gets higher. HIV treatment with HAART (Highly Active Anti-Retroviral Therapy) usually lowers the viral load. When the amount of HIV in the blood is so low that blood tests cannot find it, it is called an undetectable viral load. A person with an undetectable viral load is less likely to get sick but still has HIV and can pass the virus to others. CD4 cell count tests and viral load tests give people with HIV and their doctors’ important information about a person's HIV infection and immune system strength. These tests help show whether a person should consider taking medicines for opportunistic infections and/or medicines to fight HIV (HAART). They also show how well HAART is working. People with HIV should have a CD4 cell count and a viral load test done at least every six months. If they are taking HAART, these tests should be done at least every four months.

52. How is HIV infection treated? 

Treatment for HIV infection includes: 

·        Highly Active Anti-Retroviral Treatment (HAART) - HAART involves taking three or more drugs that fight HIV at the same time. HAART can strengthen the immune system and reduce the amount of HIV in the blood. Many medicines are available, and no one combination is best for everyone. Not everyone with HIV needs HAART, which is usually started only when signs of immune system damage or symptoms of HIV appear.

·        Preventive treatment to avoid opportunistic infections; Opportunistic illnesses affect people whose immune systems are severely weakened by HIV. However, many of these illnesses can be prevented by taking certain medicines as soon as the immune system becomes weak. Since the immune system can be severely weakened before symptoms appear, it is important for people with HIV to see their doctors so that they can begin preventive treatment as soon as it is needed.

·        Treatments for HIV-related illnesses; Treatments for AIDS-related cancers, infections, and other conditions are available. Combining these treatments with HAART, as needed, can help people with AIDS live healthier, longer lives.

·        Healthy living practices. Good health habits can play an important role in the treatment of HIV.

Important factors include:

·         Eating healthy foods o preparing and storing food safely

·         Taking vitamins as directed by a doctor or nutritionist

·         Exercise (both aerobic and muscle-building)

·         Getting enough sleep o stress management

·         Avoiding alcohol, cigarettes, street drugs, and other harmful substances. Smoking increases the risk of bacterial pneumonia, thrush, and other oral health problems.

53. When should a person with HIV begin taking HIV medicines? 

There is no one simple answer to this question. Many factors influence the decision to begin taking HIV medicines, including CD4 cell count, viral load, symptoms, concern about side effects and your ability to deal with them, and your ability to take the medicines correctly. The following recommendations are based on CD4 count, viral load, and symptoms, but people with HIV should keep in mind that personal factors are important.

Treatment is strongly recommended if:

·         Symptoms of HIV/AIDS appear; or,

·         CD4 count falls below 200.

Treatment should be offered if:

·         There are no symptoms, but CD4 count is between 200 and 350; or,

·         There are no symptoms, and CD4 count is higher than 350, but viral load is higher than 55,000 copies/mL PCR. Some experts would delay treatment at this point, but would keep checking viral load and CD4 cell counts.

Treatment is not recommended if:

·        CD4 count is higher than 350, viral load is less than 55,000 copies/ mL PCR, and there are no symptoms of HIV/AIDS. Most experts would not begin treatment and would continue checking viral load and CD4 cell counts.

54. What is the connection between HIV and TB? 

Tuberculosis (TB) is one of many diseases that a healthy immune system can usually keep under control. Only about 10% of people with normal immune systems who have the TB bacilli will get sick with active TB. However, a person with HIV who has the TB bacilli and a weak immune system is 60%more likely to develop active TB disease. Untreated active TB can be spread to others by coughing. TB can usually be cured with medicines available at DOTS centres free of cost.

55. What do people with HIV need to know about hepatitis? 

People with HIV should be tested for hepatitis A, hepatitis B, and hepatitis C. These illnesses can cause severe liver problems, especially in people with HIV. Hepatitis A is commonly spread through contaminated food or water. Hepatitis B and hepatitis C can be spread through unprotected sex or by sharing needles with a person who has either of these viruses. People with HIV should talk to their doctor about their risk for hepatitis, how to avoid infection, and whether they should receive vaccines to prevent hepatitis A and hepatitis B (there is no vaccine for hepatitis C). There are treatments available for hepatitis B and hepatitis C, but they do not work for everyone.

56. Where can pe