Frequently Asked Question on HIV/AIDS

Question: What is HIV and how does it differ from other viruses which infect human beings?

Answer: HIV stands for Human Immunodeficiency Virus. As the name suggests it only causes disease in humans, which leads to the depletion of white blood cells leading to lowering of immunity. Once the virus enters the body it lies dormant for many years and hence is known as a 'slow virus'. Most other viruses for example, those causing measles, mumps, chicken pox, etc., manifest the disease in 14-21 days after it enters the body. Hence the incubation period is short (2-3 weeks) whereas in HIV infection it is very long and runs into years.

Question: How does HIV attack the immune system?

Answer: Once HIV enters the body, it gets attached to a type of white blood cell called T lymphocyte (which is the T cell in the human body's protection against infections). The RNA (genetic material) of the virus then gets converted to DNA (genetic material) by an enzyme that the virus produces. This viral DNA then gets incorporated into the DNA of the human cell (T lymphocyte), and remains there for the lifetime of that cell. This infected cell now becomes a virus factory producing more viruses (HIV) which bud out of the cell, attack new T lymphocytes, and destroy them. Over a period of years, the T cell count of the infected person drops to a critical level and the individual develops many opportunistic infection and hence is then said to have AIDS.

Question: What is the difference between a person infected with HIV and one who has AIDS?

Answer: A person living with HIV (medically known as an HIV positive person) is one who has virus in his/her body. Such a person, remains infected and is presumed infective for the rest of his/her life. However, s/he will appear to be perfectly normal and healthy and asymptomatic for many years. An asymptomatic HIV infected person does not have Acquired Immunodeficiency Syndrome (AIDS). But when an HIV positive person's T lymphocytes (which are responsible for the immunity) count falls to 200 or less, s/he starts developing symptoms for eg. cough, fever, diarrhoea, skin lesions, etc. They are due to opportunistic infections (so called because they develop when the body's immunity becomes deficient) like TB, Thrush, Pneumonia, Cryptococcal meningitis, etc. All persons with AIDS are infected with HIV, but not all persons with HIV infection have AIDS. AIDS is only the end stage of this infection.

Question: How is HIV transmitted?

Answer: Anyone can become infected with HIV. It is transmitted only through unprotected penetrative sex (vaginal, anal, oral) with an infected partner, transfusion of infected blood and blood products, contaminate ed needles and syringes, and from an infected mother to her baby before, during delivery or through breast milk.

But since the sexual route accounts for almost 80 percent of infections, the prevalence is much higher in the sexually active age group of 15 years to 40 years. It is not who you are or where you are, but what you do that puts you at this risk of acquiring the HIV infection and eventually developing AIDS. Therefore, there are no "risk groups" but only "risk behaviors".

Question: How is HIV not transmitted?

Answer: HIV cannot spread by casual contact such as touching, holding hands, body contact in crowded public places, shaking hands, working or playing together, sharing food, vessels and clothes, eating food cooked by an infected person, light kissing, mosquito and other insect bites, swimming pools, and toilets.

Question: Do mosquitoes transmit HIV?

Answer: There is no evidence to show that mosquitoes transmit HIV. Epidemiologically,  the incidence of HIV infection is the highest among the sexually active group of 15 years to 40 years. However, mosquitoes bite persons of all age groups and if they were a means of spreading HIV, the incidence of infection would be uniformly high and among all age groups. HIV does not survive or replicate inside the intestine of the mosquito, which is another reason to believe that mosquitoes cannot spread the HIV infection.

Question: Can HIV spread through kissing?

Answer: Kissing such as on the cheek or lightly on the lips carries no risk of transmitting HIV. In deep kissing there is a small risk because the saliva of an infected person contains few virus particles which by itself is not sufficient to cause the infection. But there could be bleeding gums or ulcers in the mouth and exchange of infected saliva mixed with blood during kissing could transmit the HIV.

Question: How long can the virus live outside the human body?

Answer: The Human Immunodeficiency Virus is fragile. Once the virus is outside the body in a dry form, it dies immediately. Even in a wet state, it does not live long when exposed to heat, detergents, or disinfectants. When stored in blood banks at 4°C, it can live for about 3 weeks (or longer), or till the white cell disintegrates, but in a frozen state it can survive for years.

Question: Can I get the HIV infection if I donate blood?

Answer: No. This is not possible as all materials used for collecting blood are sterile. In fact, persons who are healthy should come forward for voluntary blood donation.

Question: What is the risk of getting HIV by going to a dentist?

Answer: The risk of getting HIV from a dentist is low. However, there have been stray reports linking the infection with dentists. Wherever there is invasive procedures of skin or mucous membrane, universal precautions should be practiced.

Question: Is the breast milk of an HIV positive woman infective?

Answer: HIV is known to be present in the breast milk of an infected woman. Hence, there is a possibility of acquiring the infection via breast milk. However, in a country like India where infant mortality is very high, the advantages of breast feeding (prevention of other infections) outweigh the risk of HIV infection through breast milk. Formula feeding should be advocated on individual cases only after proper counselling.

Question: How would one know if a baby born to an HIV positive woman has the HIV infection?

Answer: Most children born to HIV positive mothers carry HIV antibodies from the mother in their blood. These take about fifteen months to disappear. Only after that will an HIV antibody test show whether the baby is, in fact, infected with the HIV, or not. In less developed countries, the chance of a baby born to an HIV infected mother being infected is about 40 percent. But today there are antiretroviral drugs available which can be given to the pregnant woman and babies to prevent the infection in the babies. As an alternative to pregnancy, women living with HIV could also be counselled to adopt a baby.

Question: How long does it take for an HIV infected person to develop symptoms?

Answer: This depends on the mode of the HIV transmission and the lifestyle of the HIV positive person. Majority of persons who are infected through blood transfusion develop symptoms on an average from 3 years to 5 years. With the other modes of transmission when the quantum of the virus is low, the person can remain healthy for 8 to 12 years or longer. If an HIV positive person improves his/her quality of life by adopting safer sex methods, has good nutrition, regular exercise, regular medical management, emotional support, does yoga and meditation, avoids stress and regularly treats other illnesses, continues to be active, and has an optimistic outlook, s/he is likely to live longer.

Question: How does an HIV positive person progress to AIDS?

Answer: A few weeks after the virus enters the body, some people have flu-like symptoms such as fever, body ache, and headache, (every infected person may not experience these). These symptoms disappear after a while, and then there is a long phase of 3 years to 12 years which is asymptomatic. After that, when the immune system starts failing, AIDS sets in.

If a person has two major and two minor signs he is diagnosed as having AIDS. It is important to note that these symptoms are fairly common in various non-AIDS conditions also.

Question: How would I know if any of the people I meet everyday is HIV infected?

Answer: You cannot. Individuals may identify their HIV status only by doing an HIV test

Question: Is there any treatment for HIV/AIDS?

Answer: Almost all opportunistic infections a person with AIDS develops can be treated with appropriate drugs. Eg. TB, thrush, diarrhoea, pneumonia can all be treated. They can also be prevented by drugs - chemoprophylaxis. When it comes to treatment of HIV itself, there are many antiretroviral drugs available. These should be given in combinations of 2 or 3 drugs for lifetime of the patient. These drugs are expensive, have side effects and need to be monitored using laboratory tests which are very expensive.

Question: What is 'safe sex'?

Answer: Sexual activity which completely eliminates the risk of infection is safe sex. For eg. 1. any sexual activity between two uninfected people is safe. 2. any sexual activity which does not involve the entry of body fluids such as blood, semen, vaginal fluids, or other contaminated material into the body is safe

Question: What is 'safer sex'?

Answer: Safer sex is a way of adapting your sex life to minimize the risk of giving or getting the HIV infection. It includes those sexual practices which reduce the risk of acquiring or transmitting HIV during sexual activity. Sex can be made safer by using a condom consistently or by practicing non-penetrative sex.

Question: Can you get HIV from oral sex?
Yes, remember HIV is spread when you come in contact with with infected blood, semen, vaginal fluid, or breast milk. Unprotected oral sex puts you into contact with some of these fluids.

Question: Can lesbians get HIV?

Yes, remember HIV is spread when you come in contact with with infected blood, semen, vaginal fluid, or breast milk. Any activity that puts you in contact with any of these fluids puts you at risk for HIV.

Question: What can I do to protect myself against getting the HIV infection?

Answer: There is a lot you can do to keep yourself protected from getting the HIV infection:
- Learn the facts about HIV and AIDS.
- Assess your own risk behaviours (unsafe sex, sharing needles, etc.)
- Postpone, as much as possible, sex until marriage, or else practice safe or safer sex.
- Do not feel shy to talk about your doubts and fears. Get these clarified.
- Verify that any blood product you receive has been screened for HIV.
- Verify that any needles/ syringes or invasive equipment being used on you is sterile.
- If you are going for procedures such as tattooing, ear piercing, or acupuncture, verify that the equipment to be used on you is sterile.
- Avoid alcohol and drugs as they affect your judgement, and can induce you to take risks you would not otherwise take, like having unsafe sex, sharing needles, or driving rashly.
- Do not let peer pressure force you into unsafe activities.

Question: What is the role of HIV/AIDS awareness programmes in preventing the spread of HIV/AIDS?

Answer: The objective of AIDS awareness programmes is to create awareness about the problem, to give accurate and reliable information about HIV/AIDS, to clear existing myths and misconceptions, and to provide practical skills that can be implemented at the individual's level so as to lead to behaviour change that minimize the risk of HIV infection.

Question: How safe are condoms in the prevention of HIV infection?

Answer: Condoms make sex safer when used properly but they are not 100 percent safe. Safety factors to check on when buying and using condoms are,
- Expiry date of the condom - do not use one which has expired.
- Storage - condoms should be kept away from the heat (for example, from car glove compartments, direct sunlight), and pressure (for example, sitting on a wallet containing condoms).
- Making sure that sharp objects do not tear a condom during use.
- Making sure that the air is expelled from the teat of the condom while wearing, so as to prevent it from bursting during intercourse.

Question: Does the use of a condom reduce sexual pleasure?

Answer: Condoms do not reduce sexual pleasure, as sexual pleasure is a perceived pleasure. Psychologically, some people perceive a loss of pleasure when using a condom. Whereas, ribbed condoms, for example, are known to increase sexual pleasure.

Question: Do contraceptives like 'Today', diaphragm, and the pill protect a woman from getting the HIV infection?

Answer: No, they do not. These contraceptives only prevent a woman from getting pregnant but do not prevent the potentially infected semen from coming into contact with the lining of the vagina or cervix. If the HIV or organisms causing STD are present in the semen, they can still get into a woman's body and infect her.

Question: What are the different tests to detect HIV?

Answer: There are a number of tests to detect the HIV. Blood tests are done to look for specific antibodies produced by the HIV. These include,
Screening tests: ELISA (Enzyme Linked Immunosorbent Assay - the most commonly followed procedure). Spot test or Rapid Test These may give false positive results and hence should be confirmed.
Confirmatory Tests: Western Blot, the most commonly used procedure. There are other tests that are done to detect the virus or its protein or genetic material. These are however, expensive, complicated or may take long and hence, are used only for research and academic purposes.

Question: Why are consent and confidentiality important during voluntary testing?

Answer: HIV positive persons are discriminated against by family, friends, neighbours, colleagues, employers, and the society in general. Unless an individual is assured confidentiality, s/he will not come forward for testing for fear of such discrimination and stigma. Testing for HIV without consent violates human rights and should not be done. Only consented testing with pre- and post-test counselling should be encouraged.

Question: How can I know the HIV status of the person I am going to marry?

Answer: Marriages are based on mutual trust. It is important that any concerns about HIV are communicated to the prospective spouse in a sensitive and sensible manner. The HIV status of a person cannot be determined without a HIV test. A fully informed voluntary consent is a pre-requisite before a HIV test can be performed on someone. Please be prepared to likewise undergo a test should your prospective spouse so requests. In some states of USA, HIV and VDRL testing are mandated by law as pre-requisite to marriage registration. In India, there is no such law.

Question: Should premarital HIV testing be done?

Answer: This cannot be made mandatory as it would undermine confidentiality as a pre-requisite for testing. But if individuals request consented voluntary testing, it should be encouraged. Unfortunately in India, given the lack of code of conduct in reporting test results, it may be possible to "purchase" a negative result.

Question: What is ‘window period’?

Answer: The common test for HIV is screening blood for antibodies. The antibodies take 2 to 24 weeks to appear in blood. This is known as the ‘window period.’ During this period, an infected individual is infective, but the HIV tests for antibodies are negative. Hence, to be sure, the test should be repeated again 6 months after the last contact or exposure to HIV.

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