HIV

Human Immunodeficiency Virus causes HIV infection and over time acquired immunodeficiency syndrome (AIDS). AIDS is characterized by progressive failure of the immune system leading to development of life threatening diseases. HIV is largely transmitted sexually, although it might also spread through other means. Presently AIDS is a non curable infection with no preventive vaccines. However, it can be controlled through medicines which can help infected persons lead a long productive life. 

HIV and LGBTQ in India

India is home to the third largest population infected with HIV. Adult HIV prevalence in India is 0.28%. Some populations are, however, at a greater of HIV infection than others. The HIV prevalence in gay men and other men who have sex with men, is much higher 4.3%. This figure was 7.2% for transgender population. (Read more here.)These differences may occur due to risk behaviours, access to healthcare, and social acceptance among other factors.

Case reports of female-to-female transmission of HIV are rare. 

HIV and other STIs

Having another STI can increase the risk of acquiring HIV. If you are HIV-negative but have an STD, you are about three times as likely to get HIV if you have unprotected sex with someone who has HIV. The risk is especially large in case of syphilis, gonorrhea and herpes.

If you are HIV-positive and also infected with another STD, you are about 3 times as likely as other HIV-infected people to spread HIV through sexual contact. This appears to happen because there is an increased concentration of HIV in the semen and genital fluids of HIV-positive people who also are infected with another STD. 

How is HIV spread?

HIV enters the body through broken skin or skin openings and is carried in body fluids like blood, semen (cum), pre-seminal fluid (pre-cum), rectal fluids, vaginal fluids, and breast milk.

HIV is spread largely through sex with an infected partner. Anal sex is the most common way of transmission. Vaginal sex can also lead to transmission although the risk is moderate. On the other hand, there are little to no chance of getting infected through oral sex.

Other risk factors include use of infected syringes, transfusion of infected blood or any other way that a contact may happen between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids.

HIV can also be transmitted by an infected mother to her child at the time of pregnancy, childbirth or through breast milk.

However, HIV is not passed through casual contact, sharing of bedding, toilets or towels, through air or water, insects or pets, saliva, sweat, tears or closed mouth kissing.

What does HIV look like?

HIV develops in stages and can look different in each stage. Treatment can slow or prevent progression from one stage of infection to the other.

Stage 1: Acute HIV infection

Within 2-4 weeks after getting infected, person may experience flu like illness which may last for a few weeks. This stage is characterized by large amounts of virus in the blood which multiply at a faster rate.

Stage 2: Clinical Latency

This phase is largely characterized by a lack of symptoms as the virus though active, reproduces at a much slower rate. This stage may last for a decade or may end much sooner for people not getting treated for HIV. For those on treatment the stage may continue for several decades.

Since the virus is active in this stage, the infection is transmittable.

 

Stage 3: Acquired Immunodeficiency Syndrome (AIDS)

AIDS is the most severe phase of HIV infection. People with AIDS have such badly damaged immune systems that they get an increasing number of severe illnesses, called opportunistic illnesses including cancers.

Without treatment, people with AIDS typically survive about 3 years. Common symptoms of AIDS include chills, fever, sweats, swollen lymph glands, weakness, and weight loss.

How can I know if I have HIV?

The only way to know is to get tested. Symptoms may differ for different people and can easily be confused for some other disease.

 

There are multiple tests to detect HIV. However, it is not possible to detect infection immediately after contracting it. The normal HIV blood test, which detects the antibodies formed to fight the infection can be taken after 6-12 weeks (even upto 6 months for some cases). This gap period is called the window period. During this period the person can still infect others.

Some other tests that can detect HIV are:

·         Nucleic Acid Tests  look for the actual virus in the blood. It can screen the virus immediately after contraction. However, this test is very expensive and is not routinely used for HIV screening unless the person recently had a high-risk exposure or a possible exposure with early symptoms of HIV infection.

·         Antigen/antibody tests look for both HIV antibodies and antigens. Antigens are foreign substances that cause your immune system to activate. Tests that detect both antigen and antibodies are recommended for testing done in labs. There is also a rapid antigen/antibody test that may be available.

·         Antibody tests detect the presence of antibodies, proteins that a person’s body makes against HIV, not HIV itself. Most rapid tests and home tests are antibody tests.

·         ELISA (enzyme-linked immunosorbent assay): ELISA is set of blood tests used to diagnose HIV infection. ELISA test is performed by inserting a needle to draw blood. A positive result on the ELISA screening test does not necessarily mean that the person has HIV infection.

·         Western Blot: A positive ELISA test is always followed by a western blot test which confirms the HIV infection.

It is generally recommended that a person should get at least three tests done to be sure about the state of the infection as a single test may not always give an accurate result.

Who should get tested?

According to Centre for Disease Control and Prevention people with higher risk factors, such as more than one sex partner, other STDs, gay and bisexual men, sex workers, sexually active transgenders, those who inject drugs should be tested at least once a year. Pregnant mothers, and anyone who had unprotected sex with an infected person should also get tested.

How can HIV be prevented?

There is no vaccine against HIV infection. However, the risk of getting infected can be minimized through various means of PrEP, Pre-exposure prophylaxis (or PrEP) is when people at very high risk for HIV take HIV medicines daily to lower their chances of getting infected. PrEP can stop HIV from taking hold and spreading throughout your body. It is highly effective for preventing HIV if used as prescribed, but it is much less effective when not taken consistently. Daily PrEP reduces the risk of getting HIV from sex by more than 90%

PrEP can be prescribed only by a health care provider, so talk to yours to find out if PrEP is the right HIV prevention strategy for you

 

PEP

PEP (post-exposure prophylaxis) means taking antiretroviral medicines (ART) after being potentially exposed to HIV to prevent becoming infected.

PEP should be used only in emergency situations and must be started within 72 hours after a recent possible exposure to HIV. If you think you’ve recently been exposed to HIV during sex or through sharing needles and works to prepare drugs or if you’ve been sexually assaulted, talk to your health care provider or an emergency room doctor about PEP right away.

 

Other ways to minimize the risk of HIV infection

·         Protected sex using latex condoms

·         Ensuring use of fresh needles in syringes or for other reasons

·         Being in a long term monogamous sexual relation with an uninfected partner

How can HIV be treated?

 Right treatment can help people live long and productive lives even with HIV. Antiretroviral therapy (ART) can help reduce the effects of the infection. It is a combination of medicines that lower the amount of HIV in person’s blood. The treatment also reduces the risk of transmission of the infection to other people.


References:

http://www.unaids.org/en/regionscountries/countries/india

https://www.cdc.gov/hiv/basics/index.html

https://www.avert.org/professionals/hiv-around-world/asia-pacific/india

https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/26/98/hiv-and-sexually-transmitted-diseases--stds-

https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/hiv-aids/how-do-i-get-treated-hiv

https://www.nhp.gov.in/hiv-aids_pg

http://naco.gov.in/faqs