HIV stands for Human Immunodeficiency Virus. AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is a result of the development of the HIV virus into a more serious condition. AIDS was first recognised by the U.S. Centres for Disease Control and Prevention in 1981 and its cause, HIV, identified in the early 1980s.

Understanding HIV

HIV is a contagious infection which attacks the immune system, reducing its effectiveness and leaving the body susceptible to infections. The HIV infection damages the cells the body needs to fight illnesses. AIDS can be diagnosed when the number of immune system cells (CD4 cells) in the blood of a person with HIV drops below a certain level.

There is no cure for HIV or AIDS, but there are treatments that can slow down the disease, and help prevent the onset of AIDS. It takes around ten years for someone with HIV to develop AIDS, but it can be prevented with early detection and treatment of the HIV.

HIV is caught through direct contact of a mucous membrane of the blood stream with an infected bodily fluid, such as blood, semen, fluids generated through vaginal or oral sex, contaminated needles, or from mother to baby during pregnancy. HIV is diagnosed through a blood test. However, the HIV virus may only show up in the blood 3 months after contracting the infection, which is why it is important to be tested regularly.

Those with HIV are able to live a normal, healthy life with the aid of medication. However, early detection of HIV is essential to prevent it developing to AIDS.

HIV and AIDS are often stigmatised as a ‘gay disease’. This is not true – HIV is a global pandemic, affecting people all over the world from all walks of life. AIDS is widespread in African countries such as South Africa, Mozambique and Zimbabwe. Over three-quarters of deaths from AIDS have been in these areas. Lack of money, a stigma against using condoms, natural disaster and poor infrastructures contributes to this.

Being HIV positive is a hugely challenging situation to accept and deal with. As well as learning to live with the health problems, it can be difficult to tell people about the illness, due to prejudice, ignorance and stigmatisation of the illness.

Many people confuse HIV and AIDS, but it is important to remember that HIV is the initial virus that can be treated and kept under control, preventing the on-set of AIDS.

There is an annual World AIDS Day to raise awareness about AIDS and how people can protect themselves from it.

HIV in India

Here are the most recent statistics about HIV in India:

• The first case of HIV in India was identified in 1986
• Since the first India case HIV has been found in all states
• The South and North-East of India have the highest number of new cases of HIV
• Manipur has the highest prevalence of HIV
• Around 3 in every 1000 people know that they have HIV in India
• The undiagnosed population is expected to be higher
• Injecting drug users and female sex workers have the highest prevalence in India
• It is thought 2.39 million people are living with HIV in India

 

NATIONAL AIDS CONTROL PROGRAMME-III

NACP-III is based on the experiences and lessons drawn from NACP-I and II, and is built upon their strengths. Its priorities and thrust areas are drawn up accordingly and include the following:

 

• Considering that more than 99 per cent of the population in the country is free from infection, NACP-III places the highest priority on preventive efforts while, at the same time, seeks to integrate prevention with care, support and treatment.
• Sub-populations that have the highest risk of exposure to HIV will receive the highest priority in the intervention programmes. These would include sex workers, men-who-have-sex-with-men and injecting drug users. Second high priority in the intervention programmes is accorded to long-distance truckers, prisoners, migrants (including refugees) and street children.
• In the general population those who have the greater need for accessing prevention services, such as treatment of STIs, voluntary counselling and testing and condoms, will be next in the line of priority.
• NACP-III ensures that all persons who need treatment would have access to prophylaxis and management of opportunistic infections. People who need access to ART will also be assured first line ARV drugs.
• Prevention needs of children are addressed through universal provision of PPTCT services. Children who are infected are assured access to paediatric ART.
• NACP-III is committed to address the needs of persons infected and affected by HIV, especially children. This will be done through the sectors and agencies involved in child protection and welfare.  In mitigating the impact of HIV, support is also drawn from welfare agencies providing nutritional support, opportunities for income generation and other welfare services.
• NACP-III also plans to invest in community care centres to provide psycho-social support, outreach services, referrals and palliative care.
• Socio-economic determinants that make a person vulnerable also increase the risk of exposure to HIV. NACP-III will work with other agencies involved in vulnerability reduction such as women’s groups, youth groups, trade unions etc. to integrate HIV prevention into their activities.

 

Mainstreaming and partnerships are the key approaches to facilitate multi-sectoral response engaging a wide range of stakeholders. Private sector, civil society organisations, networks of people living with HIV/AIDS and government departments all have a crucial role in prevention, care, support, treatment and service delivery. Technical and financial resources of the development partners are leveraged to achieve the objectives of the programme.

Symptoms of HIV and AIDS

There are no specific symptoms caused by HIV or AIDS, which is why it is important to be tested. Instead, it is the symptoms caused by the illnesses the individual contracts due to their weakened immune system, caused by bacteria, viruses, fungi and parasites.

Shortly after the initial HIV infection, some people may experience a flu-like illness, develop a rash or have swollen glands. However, as these symptoms are so similar to many common viruses or colds, they cannot be used as a reliable indicator for contracting HIV.

An opportunistic infection is one that a healthy person without HIV can fight off. However, if a HIV positive person contracts these illnesses, in combination with a low CD-4 cell levels it may mark the development of AIDS.

Opportunistic illnesses encompass a range of illnesses. However, there are some that are far more common than others. These include:

• Bacterial diseases such as tuberculosis, pneumonia, and septicaemia.

• Gastrointestinal infections such as chronic diarrhoea and esophagitis.

• Neurological and psychiatric involvement such as toxoplasmosis and AIDS dementia complex.

• Tumours and malignancies – Kaposi’s sarcoma is the most commonly contracted tumour, and there is a higher risk of developing certain cancers including cervical, Hodgkin’s disease, oral, rectal, head, neck and lung cancers.

• fungal diseases such as PCP and penicilliosis

• viral diseases such as herpes

 

If HIV goes untreated, in the later stages symptoms may include weight loss, diarrhoea, blurred vision and a dry cough.

Causes of HIV and AIDS

HIV is a retrovirus that infects and attacks the vital organs of the immune system, causing the body to be unable to defend itself against illnesses. The virus breaks down the genetic code of cells used by the immune system, stopping it from making enough CD-4 cells to fight off illnesses.

When is the right time to seek help?

As the symptoms of HIV are similar to many common illnesses, the infection cannot be diagnosed on this alone. The definitive method is the HIV test, which tests blood for the presence of the virus. However, the virus will only show up three months after the initial infection, so those in high-risk groups must get tested regularly.

The high-risk groups are:

• gay men who have had unprotected sex
• people who have travelled extensively or lived in sub-Saharan Africa, or have had sex with someone who has
• people who inject illegal drugs, or have had sex with someone who has
• people who have had a blood transfusions in Africa, eastern Europe, countries of the former Soviet Union, or central or southern African

 

If the results of a HIV test come back positive, the individual will be referred to a whole network of support at a HIV clinic, and have access to a counsellor, social worker, dietician, dentists, specialist doctors and a pharmacist.

A HIV test is a blood test, done either from a pin prick on the finger or taking blood from the arm. After a positive diagnosis, it is important for the individual to contact current and previous sexual partners to let them know there is a risk they may also be infected, and that they need to get tested. This can be a difficult process, but professionals are on hand to help.

It is also important to inform employers of a HIV positive diagnosis, as those with HIV are protected under the Disability Discrimination Act. The individual is not obliged to inform their employer, but will not be covered by the act unless they do so.

For friends and family of someone with HIV, it can be difficult to accept the diagnosis. Counselling can help work through issues that have arisen, and offer advice on how best to support the individual.

PEP (Post Exposure Prophylaxis) is a treatment that can be taken within 72 hours after suspected HIV infection that may prevent the infection developing. It is not guaranteed to work, and does involve taking the drug for four weeks. There are also side effects, including diarrhoea, sickness and vomiting and headaches.

 

 

Treatment for HIV and AIDS

There are many regular procedures HIV patients need to undergo as part of their on-going treatment. Everyone diagnosed with HIV should be offered counselling, and this can prove invaluable in coping and explaining the illness to others.

There is treatment available for HIV which will slow down the progression of the virus, allowing people to lead a normal life. This treatment is called highly active antiretroviral therapy (HAART), and is a combination of medicines administered in two or three pills to be taken once or twice daily. The medication involves commitment – the individual will have to take these drugs every day for the rest of their life, as well as making sure they stay healthy, eat well, exercise regularly and try and avoid being exposed to illnesses where possible. They will also need to have regular blood tests to monitor the HIV.

In the later stages of AIDS, a person will need palliative care and emotional support as they prepare for death. Counselling can provide support to both those diagnosed with the disease, and their friends and family.

Strategic Information Management Systems (SIMS)

Component 5 of National Aids Control Programme-III, the Strategic Information Management Systems (SIMS) is already rolled out and is on-going with an aim for it be firmly established at all levels to support evidence based planning, program monitoring and measuring of programmatic impacts. The surveillance system is to be further strengthened with focus on tracking the epidemic, incidence analysis, identifying pockets of infection and estimating the burden of infection. Research priorities are also be customized to the emerging needs of the program. NACP IV will also document, manage and disseminate evidence and effective utilization of programmatic and research data. The relevant, measurable and verifiable indicators will be identified and used appropriately.

Services for Prevention The HIV epidemic in India is concentrated among high risk groups (sex workers, men-having-sex-with-men, injecting drug users and clients of sex workers), though there is evidence of the infection spreading to the general population. About one-third of districts in the country have high HIV prevalence. To contain the infection, NACP-III consolidates efforts in prevention, care, support and treatment of HIV/AIDS. Under the plan all HIV/AIDS linked services are integrated and scaled up to sub-district and community level. However, the services available in any area are based on the prevalence there. This is made necessary as HIV/AIDS in India presents heterogeneous epidemiology with high rate of prevalence, more than one per cent in general population in some districts and low prevalence in others. Core Services at District level In packaging of services, care is taken for the special needs of the region and availability of complementary healthcare system. In high prevalence districts, the full spectrum of preventive, supportive and curative services are available in medical colleges or district hospitals. These hospitals provide HIV/AIDS prevention services including treatment and cure for sexually transmitted infections, psycho-social counselling and support for people infected or affected by HIV, management of opportunistic infections and anti-retroviral therapy (ART) for people living with HIV/AIDS, counselling and testing facility for prevention of parent to child transmission of HIV infection, specialised paediatric HIV care and treatment as well as referral for specialist needs such as surgery, ENT and ophthalmology etc. Community Health Centres  (CHCs) give Basic Services Community Health Centres and Primary Health Centres are integrated in the programme and facilitate prevention through promotion of condoms, counselling and testing for HIV (ICT Centres), prevention of parent to child transmission (PPTCT), treatment and cure for sexually transmitted diseases and management of opportunistic infections. Community Based Organisations for better Service Outreach Hospitals providing HIV services are linked to NGOs/CBOs which play a significant role in providing peer support services and home-based care for people living with HIV/AIDS. CBOs also facilitate follow-up with children born to HIV positive women, support at the community level and outreach to services at the district level.

What should I be looking for in a counsellor or psychotherapist?

There are currently no official rules or regulations stipulating what level of training a counsellor dealing with HIV/AIDS needs. However, it is recommended that you check to see if your counsellor or therapist is experienced in this area.

Another way to assure they have undergone specialist training is to check if they belong to a relevant professional organisation representing counsellors dealing with HIV/AIDS.

HIV/AIDS can affect not only the sufferer, but also partners and family. In these cases you may wish to seek couples and/or family counselling for additional support. Some people also find it beneficial to join a support group with others living with HIV/AIDS.