Analysis: A cure for HIV?

By James Gallagher Health and science reporter, BBC News

A baby girl has been “functionally cured” of HIV in the US. The difference it will make to her life could be huge – avoiding a lifetime of medication, social stigma and worries about whether to tell friends and family.

But beyond the personal story, there is a huge question – does this bring us any closer to an HIV cure?

There are very special circumstances involved in the US case. Doctors were able to hit the virus hard and early. This is not possible in adults, who will acquire HIV months if not years before they find out.

Even in the UK, where at-risk groups are offered free regular testing – one in four people with HIV is unaware they have the virus. By the time they find out, it will be fully established – hiding away in reservoirs in the immune system that no therapy around can touch.

It is also unclear how a newborn’s immune system, babies still get much of their protection from their mother through breast milk, may affect treatment.

One thing is certain – this approach is not going to provide a cure for the vast majority of people with HIV.

So what about about somebody who has been living with HIV for a decade? Any hope of a cure for them?

The first thing to note is that HIV is not the killer it used to be.

It first emerged in Africa in the early 20th Century and became a global health problem by the 1980s. In the early days, there was no treatment, never mind talk of a cure.

The virus claimed the lives of more than 25 million people in the past three decades, according to the World Health Organization.

Then, good antiretroviral therapies emerged in the mid-1990s and the impact it had on the number of deaths was dramatic.
Aids deaths

People infected with HIV should have a near normal lifespan if they have access to treatment. Of course this is a big “if”. Nearly 70% of people living with HIV are in sub-Saharan Africa, where access to drugs is relatively poor.

HIV stands for human immunodeficiency virus and on its own it does not kill you.

The virus can survive and grow only by infecting, and destroying, the immune system.

This continual assault on the immune system makes it weaker and weaker until it is no longer able to fight off infections.

Without treatment, it takes about 10 years from infection to the development of Aids – acquired immune deficiency syndrome.

It is then that “opportunistic infections”, ones a healthy immune system could fight off, become deadly.

People can die from pneumonias, brain infections, diarrhoeal illnesses as well as certain tumours such as lymphoma and cervical cancer.

The hunt is on for a cure.

“We had always assumed that it was impossible, but we’ve started to discover things we didn’t know before and it’s opening up a chink in the armour,” Dr John Frater, from the University of Oxford, told the BBC.

“A cure is something we can no longer write off as impossible.”

After HIV first infects the patient, the virus spreads rapidly, infecting cells all over the body.

Then, the virus hides inside DNA where it is untouchable.

But there are now experimental cancer drugs that might be able to flush the virus out and make it vulnerable.

Dr Frater said: “It turns on a virus inside a cell and it becomes visible to the immune system and we can target it with a vaccine.”

However, this approach requires drugs to make the virus active and a vaccine to train the immune system to finish it off – this is not just round the corner.

“We are a long, long way away, in truth,” said Dr Frater.

There is another route being considered – involving a rare mutation that leaves people resistant to HIV infection.

In 2007, Timothy Ray Brown became the first patient believed to have recovered from HIV. His immune system was destroyed as part of leukaemia treatment. It was then restored with a stem-cell transplant from a patient with the mutation.

A little bit of genetic engineering may also help to modify a patient’s own immune system so that it has the protective mutation. Once again this is a distant prospect.

Chairman of the UK-wide Aids vaccine programme Prof Jonathan Weber, from Imperial College, said: “For established infection we have some ideas, but it is all in the realms of experimental medicine.

“There is no consensus and no clear way forward.”

Is a world without Aids possible?

He added a cure would be very cost-effective, as giving people drugs every day of their life was expensive.

Prof Jane Anderson, consultant at Homerton hospital in London, expressed caution about expecting a cure after the case in the US.

“This is a very exciting moment, but it is not the answer in today’s world.

“I’m worried that we so desperately want a cure that we forget the cost-effective stuff that does make a difference.”

Nearly every case of mother-to-child transmission can be prevented by drugs, caesarean section and not breastfeeding. And in adults, most cases are as a result of unsafe sex.

HIV really is an infection where prevention is much easier than cure.

Getting Tested for HIV

by Jay Vithalani

Getting tested for HIV is never easy. Some people hate needles. Some people are so terrified at the prospect of a “positive” result that they refuse to get tested. Others justify their “test abstinence” by adopting a fatalistic attitude: what good will it do to know my HIV status given that I can do nothing about it? There are also some misconceptions about HIV testing, for instance that the tests are expensive and unreliable.

I want to respond to some of these fears and clear some misconceptions in this brief article. Outlined here are some fundamentals of HIV testing, along with some reasons for getting tested if you are sexually active. Some of the material may seem painfully elementary to the initiated, while a small portion may be a little technical. The aim has been to be comprehensive and as jargon-free as possible. There is also a paragraph about PEP, or post-exposure prophylaxis. Finally, there is a list of testing centres in Mumbai, with basic contact information.
~~~~~~~~~~~~~~ I. Facts and Vocabulary

(1) HIV: The acronym stands for Human Immunodefiency Virus, the virus which causes AIDS (Acquired ImmunoDefiency Syndrome). HIV is a relatively difficult virus to contract (Hepatitis B, for instance, is ten times more infectious). HIV works by destroying the body’s natural immune system, thus leaving the body vulnerable to a host of infections. Not everyone who is HIV-positive has AIDS. A person has AIDS only when the body’s immunity falls below a certain level. There are many millions of people who are HIV-positive who don’t have AIDS, thanks largely to drugs developed over the last 20 years. While there have been great advances in the treatment of HIV and AIDS in the last decade, no current treatment eliminates the virus from the body or cures AIDS.

(2) Antibodies: These are cells produced by the body in response to a particular infection. The human body can deal with many mild infections. Thanks to our antibodies, we have either a resistance to or the capacity to deal with infections like the common cold.

(3) Antigens: These are the little things which cause infection, usually a virus or a bacterium.

(4) ELISA: This stands for Enzyme Linked ImmunoAssay, which is quite a mouthful and not in a good way. It’s a very common test procedure in labs. The ELISA test for HIV/AIDS is the standard screening test used to determine whether or not a person is HIV-positive. The ELISA doesn’t detect the virus itself but rather the antibodies the body produces in response to HIV. It is cheap, easy for labs to perform, and extremely accurate (greater than 99%).

(5) Western Blot: This is a much more complicated test than ELISA, used only to confirm a positive ELISA result. It, too, tests for antibodies and not the antigen itself. The Western Blot is not a screening test but a confirmatory test. It is many times more expensive than the ELISA. A person getting routinely tested should almost never get a Western Blot; ELISA is generally accepted as the best first-line test.

(6) Seroconversion: If HIV enters the body, the immune system produces antibodies in response. Seroconversion is the process by which a previously negative person becomes HIV-positive (serum being a big component of blood). Even if HIV has entered the body, a person isn’t technically HIV-positive until antibodies in response to the virus have been produced. The time it takes people to seroconvert varies greatly between individuals. Some people seroconvert (produce antibodies) in a few days, some people take much longer. About 50% seroconvert within 25 days of exposure to HIV. Over 99% seroconvert within 90 days. There have been very rare and isolated cases of seroconversion taking longer than three months.

(7) Window period: Since the ELISA test looks for antibodies rather than the virus itself, you can’t get tested just one hour after a potential exposure. Antibodies can take up to 90 days to appear. After a potential exposure, you should wait for three months before getting tested. A test prior to that wouldn’t be considered accurate, since the virus may be in your body but your body may not have produced antibodies to it. This 90-day period is known as the window period.

(8) Test accuracy (sensitivity and specificity): Both the ELISA and the Western Blot are highly accurate tests. That is to say, in testing jargon, they are both sensitive and specific. For complex reasons, though, high specificity in a test usually comes at the expense of some sensitivity and vice versa. It’s possible to illustrate these two concepts with a simple example. Imagine a bag filled with 1,000 marbles. Most of the marbles are white, let’s say 990 of them. Three marbles are red and seven are yellow. Now, I want to design a test which will detect the presence of the red marbles in the bag. If we say that the red marbles are antibodies to HIV produced by the body and the yellow marbles are antibodies (or other agents) unrelated to HIV, then both the ELISA and Western Blot are extremely good at detecting the red marbles in a crowded bag. Yet, there is a difference between them. ELISA is a highly sensitive test – it is possible, in a very small minority of cases, that it will detect a yellow marble and mistake it for a red one. This is why a positive ELISA has to be confirmed with the Western Blot. The WB is an extremely specific test. It can detect only red marbles. It is theoretically possible, in a vanishing small percentage, that it might “miss” the red marbles, but it will never mistake a yellow (non-HIV) marble for a red (HIV) one. That’s why, for a positive test result, the two tests are used in conjunction.

(9) False positive, false negative: After having said that the tests are extremely accurate (sensitive and specific), every test designed has a certain (very small) degree of fallibility inherent in it. A false positive result is one in which the person tests positive but is in fact negative. This happens in a very small proportion of ELISA tests; in our example above, in the case of a false positive result, the test has mistaken a yellow marble for a red one. So the Western Blot is carried out, which would reveal that the person was in fact negative. A false negative result, on the other hand, is one in which a person is actually positive but the test result comes back as negative. This is most often due to testing having taken place during the window period, before antibodies to HIV have developed.

(10) Rapid testing: The time it takes for ELISA results to come back from the lab varies from same-day results (at some labs, if you go bright and early) to a week or more. Of course, this waiting period can be a time of anxiety and stress. (Some people don’t even go to pick up their results.) Recently, tests have been developed which return a result in 15 to 30 minutes and which perform at ELISA-like accuracy. These rapid tests are now available in large Indian cities like Delhi and Mumbai. Newer versions of the rapid test, available abroad, can even be performed using saliva rather than blood. (In a positive person, saliva has a very low concentration of HIV, enough for detection but not transmission.) It should be added that rapid tests are also antibody tests, like the conventional ELISA and Western Blot, and so the 90-day window period applies to them as well. And if a result comes back positive, it should be confirmed, as always, with the Western Blot.

(11) Other tests: There are tests available which detect the presence of the antigen (virus) rather than the antibodies. The best-known of these is a family of tests using a technique called PCR. They are pretty expensive and technically very complex. But they seem to offer one clear advantage over the antibody tests: since they are looking for the virus itself, with PCR tests you don’t have to bother with the wait and anxiety of the window period. However, the disadvantages of using PCR testing as a first or diagnostic tool are many. First, even with PCR, it is recommended that you wait 28 days after a potential exposure to get the test, since it can take that long for the virus to reach detectable levels in blood. Second, given the complexity of the testing method, PCR tests are more prone to lab error. Third, PCR tests are so sensitive (see above) that they have a much higher rate of false positives than antibody tests. Fourth, they are not considered as definitive diagnostic tools (in other words, a negative or a positive result would have to confirmed at a later date by the conventional antibody tests). Fifth, the expense.

(12) Anonymous vs confidential testing: A confidential test is one in which a lab performs the test for an individual (under his or her name) but doesn’t disclose the test results to anyone other than the person tested or without his/her consent. In an anonymous test, no names are used. The person tested is assigned a number at the time the test is performed. To pick up the results, you present the slip with that number. Obviously, anonymous tests offer a greater measure of privacy than confidential tests. If you’re worried about using your name for a test, you should opt for anonymous testing. Many private labs, however, will perform HIV testing only with a doctor’s prescription.

(13) Counselling: In an ideal testing situation, you would be counselled by a trained person both before the test is performed and after you receive the result (whether the result is positive or negative). Why is counselling important? Well, for one, HIV testing can be a stressful event and a trained counsellor can help you understand and relieve the stress. Second, pre- and post-test counselling is a good time for you to review your safer sex practices with someone who can answer questions and allay doubts. Third, if the test result is positive, a counsellor can speak to you specifically about living with HIV, and if the result is negative, he or she can can help you go over your commitment to remaining so.
II. Why Get Tested?

So you’re thinking of getting an HIV test but still have some doubts. Should you go to that dreaded lab or not? Here are some thoughts on why getting tested is probably a good idea.

(1) If you’re one of the “Worried Well” – the many, many people who are anxious about their HIV status, regardless of their sexual history or risk – then getting a test is a good idea. Your negative status will be confirmed and you can carry on with your life, or obsess about something else.

(2) Knowledge is power. Knowing your status can help you make informed decisions. If you are in fact positive, knowing your status early can be vital in making treatment decisions; this is borne out by both common sense and studies which show that the later that HIV infection is diagnosed, the worse the prognosis. If you have a sexual partner or partners, knowing your status can also help you make decisions about safer sex.

(3) “Why should I get tested when there’s nothing I can do?” The answer to that is: HIV and AIDS are serious conditions, there is of course no doubt of that. But there are two common misconceptions: First, that HIV=AIDS, which is not the case, and second, that being infected with HIV is an automatic death sentence, which it is not. Drug therapy is becoming increasingly available and affordable, and has helped literally millions of people around the world live more or less normal lives with their HIV infection. And many people don’t need antiretroviral therapy for many years after being diagnosed with HIV. Also, new drugs therapies are being developed every year. It is hoped that, within the next decade or two, HIV will become a chronic but manageable condition, like heart disease or diabetes. Giving up hope is not the answer.

(4) Making an annual HIV test part of your routine medical check-up – like an annual mammogram for women over 40 or a periodic blood-pressure check for all businessmen – may be less stressful than going for a test every time you’re irrationally anxious or think you’ve had potentially unsafe sex. While it becomes part of your annual routine, it can also serve as a kind of “reality check”: a reminder that you’re relieved that you’re (probably) negative, that you will remain so, while continuing to enjoy (safer) sex.
III. PEP – post-exposure prophylaxis

This stands for post-exposure prophylaxis (which is a fancy word for prevention). If someone has potentially been exposed to HIV, either in a healthcare setting (a doctor getting an accidental prick from a needle which has been used on a positive patient) or sexually (receptive anal sex, for example, with a person of unknown status) – in both of these situations, PEP can drastically reduce the chances of being infected with HIV. The exposed person takes a course of antiretroviral drugs for 28 days (usually a combination of AZT and 3TC), with the preventive therapy beginning within 72 hours of the exposure. The sooner the therapy is started after the exposure event the more effective it is thought to be. Basically, PEP works by eliminating HIV before it can establish itself in the body. It is sometimes called the “morning after” pill for HIV. Except that the PEP course is 28 days and needs to be followed by the usual tests 90 days or more after exposure. The cost and possible side-effects of the drugs (and probably the psychological trauma as well) mean that PEP is not a blank cheque given to irresponsible barebackers. Used wisely, PEP can be can effective tool in reducing the incidence of HIV.

IV. Testing CentresThere are a number of centres where the test can be done, at costs ranging from nothing to around Rs750/-. This is one case where more money does not necessarily imply better service. Many of the best services, with excellent technical facilities and proper pre-test counselling, and post-test counselling (if the person tests positive) are in the free or low-cost testing centres operated by the government and NGOs.

But these may not be convenient for everyone to access, in which case one can go to the more reputed private centres – but with a cost and no counselling.

(1) Humsafar Center – If you’re looking for a gay-sensitive place for testing, the obvious place is the Humsafar centre in Vile Parle (East), which now does testing six days a week. Earlier the reports had to be collected from Sion Hospital, but now everything is done at the centre. Humsafar now also has counsellors working in five large public hospitals across the city, so one can go to these places for testing and specifically contact these counsellors (on specific days of the week):Humsafar Centre, Vile Parle (East) – 26673800/26650547, ask for Mr.Murgesh, 6 days a week, 4.00 p.m. to 8 p.m.

Other centres with Humsafar counsellors: Borivili: Bhagwati Hospital – contact Mr.Ashok, 9833239249Ghatkopar: Rajawadi Hospital – contact Mr.Shashi, 9892838163, Mon/Tues/WedJuhu: Cooper Hospital – contact Mr.Shyam, 9892822150, Tues/Thurs/Sat

Parel: KEM Hospital – contact Mr.Sandeep, 9819386511, Mon/Wed/FriSion: Sion Hospital – contact Mr.Harish, 9870457574, all days

(2) Saadhan Centres – these are run by Population Services International, a NGO which also ensures that its staff is fully gay-sensitised and gives excellent all round counselling. It uses the rapid test which means you will get the results in one hour. Saadhan has a single helpline which can be called for all details – 2389-2222.
Clinic locations are: Saadhan Clinic-Vashi (Mobile Van), Vashi Truck Terminus, Sector 19, Opp Jhunkha Bhakar kendra, Vashi. M-F 10 am – 6 pm.Saadhan Clinic-Kamathipura, Mumbai- A/50, 7th Lane, Close to jayshree masala centre, Kamathipura, Mumbai 400008. M-F 10 am – 6 pm.Saadhan Clinic-Cotton Green, Mumbai-1st Floor, Opp Ram Mandir, Air Force Station, Cotton Green, Mumbai 400 033. M-F 10 am – 6 pm.

(3) Dr.Amin’s Pathology Laboratory, Tulsiani Chambers, Nariman Point – no counselling, it costs Rs450/- and you have to go by 2.00 p.m. to get the report by 5.30 p.m. the same day. The advantage is that it’s easily accessible for many people in Nariman Point and they will not require a referral from a doctor – you can just walk in. Tel: 22825230 / 22822471 / 22822472 / 22884262

HIV Testing

If you remotely doubt that you are H.I.V. infected, get yourself tested at the following recommended testing Centers.

Getting tested for HIV/AIDS


In case people are interested in getting themselves tested for HIV/AIDS, here’s some information on how:

The basic test can be done at a number of places, and the costs vary. The last time I had one done through my rather expensive GP at Pedder Road it cost 600/-. But its possible to have a reliable test done with proper pre-test counselling (and post test too, of course, in case the result is positve) at no cost.

All one has to do is go to Sion Hospital to Out Patients Depatment #16 (OPD 16 or Skin OPD as its called). Its on the 2nd floor of the New College Building in Sion Hospital, and you can ask to speak to Dr.Maninder Sethia, or to Drs Anand, Santosh or Gautam. The phone number is 4043732.

You can go any day from 9.00-12.00 am and they’ll take the blood sample, and you’ll get the test result 6 days later, though I think they prefer if you come on a Friday or Saturday, when they have full counselling support. I think there’s a pretest counsellor there called Mr.Neil all the time.

Alternately, the sample can be given at the Humsafar centre in Santacruz East, on Tuesdays, Wednesdays and Saturdays from 5.00-8.00 pm. The doctors from Sion Hospital who will be there at those times will give a full check up for all sexually transmitted diseases, and will take the blood sample for the HIV test. The results will have to be collected from Sion Hospital though since they feel that the post test counselling, if needed, is best done in the hospital.

Please note that in both places the testing is absolutely free, is very thorough, and that your confidentiality will be absolutely respected. If you can’t go to Humsafar, but are still apprehensive of how you’ll be treated at the hospital, you can tell them you have been referred through Humsafar and you will be treated separately, with some formalities waived and given a separate area in which to wait.

There’s no easy way to do testing, or to alleviate the anxieties that come with doing it (no matter how safe you think you’ve been). But it is possible to do it fairly efficiently and with proper counselling available if needed and this is how.

A new voluntary testing facility connected to Humsafar Trust goes on line on December 1st, World AIDS Day this year.

The VTC is at the Cooper Hospital’s blood bank section behind the new OPD.It will be open every day between 9 a.m. to 1 p.m. However, the Humsafar Trust’s pre-test and post test counselors and positive person group manager sit in Ward 24 near by for any help needed only on Tuesday and Thursdays.

The Address:
Cooper Hospital Blood Bank
Please ask for Dr. Jayanti Shastri
Behind Cooper Hospital OPD
Juhu Vile-Parle Scheme
Mumbai 400049

This facility of the Humsafar Center for positive persons from the gay and MSM community also counsels the women partners of MSM and an average of eight persons attend the counselor’s sessions each Tuesday and Thursday between 9 a.m.and 1 p.m.

The VTC started after advocacy with the BMC health authorities that MSM did not have any facility in the western suburbs.

The VTC is open to everyone on all days but it is open with a special counselor for MSM only on Tuesdays and Thursdays.

New Delhi
In New Delhi, the following 4 Testing facilities are on the referral of Naz Foundation (I) Trust. Since the Naz Foundation has been interacting with these agencies for a while, they’re fairly sensitive to realted HIV and MSM issues. In addition, there are scores of private clinics in delhi but they are quite exorbitant.

  • Safdarjung Hospital
    Model Counseling Center
    Room No. 542
    5th floor
    New OPD Building
    Tel: 6198438, 6165060, 6165032
    Timings: (for making the card): 9 AM to 11 AM
    Charges: Free
    Test result: In 7 days
  • Specialty Ranbaxy Limited
    C/o Indian Spinal Injuries Center
    Vasant Kunj
    New Delhi- 110070
    Ph: 6137615, 6137573
    Timings: You need to take an appointment on phone
    Cost: General- Rs. 375
    Naz referral- Rs. 300
    Test result: 3 days
  • National Institute of Communicable Diseases (NICD)
    Shamnath Marg, New Delhi
    Ph: 3934517, 3971060
    Timings: You need to take an appointment on phone
    Cost: Free
    Test result: 7 days
  • Dr. Lal Pathlabs Pvt. Ltd.
    54, Hanuman Road,
    Connaught Place
    New Delhi- 110001
    Ph: 3746426, 3342046, 3342075
    Cost: Rs. 350
    Test Result: Next Day
  • – Vikram

What Next After Testing Positive?

Here’s a mail that I had written sometime back that answers exactly your questions. I had also posted on the lists, but I really need to find the time to put stuff like this on the website. Pass it on to your friend and ask him to go through it and see what questions he has. If he’s willing he can mail me directly or can send through you.

I would still recommend he considers the counsellors at Humsafar. They really do have decent confidentiality procedures and the fact that they will be sensitised to gay men and HIV is in itself worth a huge deal. There is seriously bad shit that has come from private doctors who are not sensitised to this issue at all and give such terrible advice that in some cases they have clearly hastened the entirely unnecessaary deaths of their patients.

If he’s not willing to consider Humsafar, or Sion Hospital (the Skin/OPD department which is probably the most sensitised place on HIV and gays other than Humsafar) there is a third option which is typical of our Indian system – the doctors from Sion Hospital who are also doing privte practice. Dr.Hemangi Jerajani, who was running the Sion programme, is now consulting somewhere in Versova, I think, and she has helped a number of gay men who have gone to her about this.

Cost levels will vary for all this. Humsafar/Sion is almost free, Dr.Hema will be a bit more and the private guys, which are the worst option, will be the most expensive! There are a few private guys who are good and worth going to, like Dr.Joshi who I’ve dealt with a bit, but it is almost impossible getting an apointment with him (and definitely impossible for the next few months since he’s on some big project, he had to turn away a guy I sent to him recently).

The cost he cannot skip – I mention it below, but am re-emphasising it – is the cost of regular testing for CD4, CD8, viral load. In the long term as the virus stabilises he could possibly do it less often, but in the short term he needs to do it regularly.

Here’s the mail I had sent:

Now that you have tested positive you will need to find at least three kinds of support:

1) A counsellor with some understanding of gay/bi issues and HIV who can help you with the consequences of this for you and your family. Whether you are out or not, or have a supportive environment or not, will all affect your interaction with HIV, and it is best to be prepared for both practical and emotional issues, and a counselor can help with these.

2) A really up to date and knowledgeable HIV/AIDS specialist. This is harder to find than one might imagine despite the large organisational structure for HIV/AIDS. Most private doctors, quite frankly, know nothing about it and the ones with most experiences are in public hospitals. But these are not the easiest of places to visit and in any case their focus is, rightly, on mass treatment, and not quite geared towards someone who is middle class and able to bear some of the expenses of the treatment. In other words, the government/NGO system focuses, as it must, on large scale, free treatment and cannot be adjusted that much to each individual patient. But ideally with a disease like HIV, where each person’s prognosis can be very different, this individualised treatment is needed and if you are in a position to get it, you must.

3) A physician who will treat your regular illnesses with some knowledge of your HIV status. While the physician should treat your illnesses for what they are, it is possible that it might be best if it is known that HIV is a background factor, so you need a doctor with some knowledge of this. This may not be that critical at the moment, since you are most likely quite healthy now and will be for a while, and this will not be an issue. At some point in time though it might, but hopefully by then you will be better networked with the HIV support scene. Getting in touch with a HIV support group is also a good option to consider at a later point.

OK, but for now, you need to relax. What’s happened isn’t wonderful, but its not the end of the world. The problem with HIV is that it comes with all the stigma and fear and in your case this will be multiplied by concerns about your family. But you need to remind yourself that:

a) It is just a disease, it is not a moral judgment on you.

b) It is not fiercely contagious. The saving thing about HIV is, in fact, that it is a virus that is quite hard to get. You need direct contact of certain kinds of bodily fluid – blood, semen, precum (it is there in saliva but at such low levels you don’t need to get worked up about it). The virus also dies quite fast outside the body. So you are not risking infecting people by just being around them. (I need hardly say that you have to be careful about sexual partners and if you have had unprotected sex with anyone recently then you might need to consider telling those partners).

c) You can have a quite normal lifespan. One way to look at it is that you have acquired a medical condition like diabetes. This can be serious and cause all kinds of complications if it is not treated, but it is quite possible to treat it and build that treatment into your life.

At some point you will probably need to start taking the drugs and yes, in the past the side effects were not great. But newer treatment regimens have reduced this to a large extent and if you find a good specialist you should be able to increase the chance that you will get a fairly problem free treatment regimen.

As to when you will have to start treatment that is harder to say and it is why a specialist is needed. Please don’t listen when doctors says, as they often do, that you only need to start starting treatment when your CD4s cells drop below 200. This is the norm set by the government in connection to administration of free medicines, and it is no surprise that they have chosen a level that makes optimum sense for them (in terms of total cost) as well as the patient.

But you don’t have to be bound by this and can decide what will be the optimum point for you. The tendency in the West now is to start treatment much earlier – specialists may recommend starting when CD4s fall below 350, or if they show a rapid decline.

Please don’t believe one myth that floats around which is that after starting treatment you only have that many years to live. Such claims are based on mass studies, with people who often don’t have access to healthy food and living conditions, and this should not apply to you. I hope I don’t need to say that you need to focus very strongly on maintaining your health in general. (Alternate healing practices like yoga can’t cure HIV, but they can help here, in improving your general health and reducing stress).

What you will have to start doing now and this unfortunately does involve real costs, far more than that of the drugs themselves, is to start monitoring yourself more often. This involves going to a good path lab – I think its best to stick to the large national chains like Metropolis if that’s there where you are – and doing a HIV package which will show two things: 1) virus levels and 2) CD4 levels (and other white blood cells). These will vary inversely, but its not easy analysing them – virus levels in particular can vary alarmingly without it meaning much. This is where the specialist is vital.

The cost of the testing package is around Rs4500 and this is an expense you HAVE to find money for, at least in this initial phase as your body gets used to the presence of the virus in it. I would suggest you do tests every 2-3 months for the first year and then, as you get a sense of how the virus is settling down in your body you can do them less, but once every six months is a minimum. The cost of these tests is the real financial blow with HIV and while there has been some work being done on bringing them down or providing free tests at government hospitals, this is all still a problem.

All this is a lot for you to process so please take your time to go through them. Please consider seeing a counsellor to help you deal with personal issues, as well as a good doctor.  You will be surprised, once these are in places and you are taking good care of your health and being aware of, but not obsessing, about your condition, how routine it can come to seem. Never entirely routine, of course, but manageable and certainly no reason not lead a normal life.

all the best

written by Vikram


1.   What Is HIV?

“HIV” stands for Human Immunodeficiency Virus.

Many people also refer to HIV as the “AIDS virus.”

HIV lives in the blood and other body fluids that contain blood or white blood cells.

2.   HIV and AIDS

Human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS), a condition in which the immune system begins to fail, leading to life-threatening opportunistic infections.

Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast milk.

When the virus enters the body, HIV begins to disable the body’s immune system by using the body’s aggressive immune responses to the virus to infect, replicate and kill immune system cells. The gradual deterioration of the immune function leads to AIDS.

3.   What is AIDS?

Acquired Immunodeficiency Syndrome (AIDS) is the final stage of HIV infection. The Centers for Disease Control establish the definition of AIDS, which occurs in HIV-infected persons with fewer than 200 CD4+T cells and/or persons with HIV who develop certain opportunistic infections.

4.   What are CD4+T or T4 cells?

CD4+T cells, also called T4 cells, are the immune system’s key infection fighters.

The T4 cells are disabled and destroyed by HIV, often with no symptoms, causing a significant decrease in the blood levels of these cells.

In the advanced stages of HIV, the body may have fewer than 200 T4 cells, while a healthy adult’s count is 1,000 or more.

In this way, the body’s immune system is continuously weakened from the moment of infection and the inability of the immune system to fight infection opens the door to opportunistic infections.

  1. What are Opportunistic Infections?

Opportunistic infections are a result of the weakened immune system present in persons with HIV/AIDS.

An infection takes the “opportunity” provided by the weakened immune system to cause an illness that is usually controlled by a healthy immune system.

These infections are sometimes life-threatening and require medical intervention to prevent or treat serious illnesses.

Persons living with advanced HIV infection suffer opportunistic infections of the lungs, brain, eyes and other organs.


Unsafe sex has a high risk of spreading HIV.

The greatest risk is when blood or sexual fluid touches the soft, moist areas (mucous membrane) inside the rectum, vagina, mouth, nose, or at the tip of the penis. These can be damaged easily, which gives HIV a way to get into the body.

Vaginal or rectal intercourse without protection is very unsafe. Sexual fluids enter the body, and wherever a man’s penis is inserted, it can cause small tears that make HIV infection more likely.

The receptive partner is more likely to be infected, although HIV might be able to enter the penis, especially if it has contact with HIV-infected blood or vaginal fluids for a long time or if it has any open sores.


Most sexual activity carries some risk of spreading HIV. To reduce the risk, you should make it more difficult for blood or sexual fluid to get into your body.

Be aware of your body and your partner’s.
Cuts, sores, or bleeding gums increase the risk of spreading HIV.
Rough physical activity also increases the risk.
Even small injuries give HIV a way to get into the body.

Use a barrier to prevent contact with your partner’s blood or sexual fluid.

Remember that the body’s natural barrier is the skin.
If you don’t have any cuts or sores, your skin will protect you against infection. However, in rare cases HIV can get into the body through healthy mucous membranes. The risk of infection is much higher if the membranes are damaged.

The most common artificial barrier is a CONDOM for men.


A condom is a tube made of thin, flexible material. It is closed at one end. Condoms have been used for a long time to prevent pregnancy by keeping a man’s semen out of a woman’s vagina.

Condoms also help prevent diseases that are spread by semen or by contact with infected sores in the genital area, including HIV.

A new type of condom was designed to fit into a woman’s vagina.

  1. More about CONDOMS:
  • When used correctly, condoms are the best way to prevent the spread of HIV during sexual activity.
  • Condoms can protect the mouth, vagina or rectum from HIV-infected semen.
  • They can protect the penis from HIV-infected vaginal fluids and blood in the mouth, vagina, or rectum.
  • They reduce the risk of spreading other sexually transmitted diseases.
  1. Wearing a Condom correctly:
  • Put the condom on when your penis is erect – but before it touches your partner’s mouth or rectum. Many couples use a condom too late, after some initial penetration. Direct genital contact can transmit some diseases. The liquid that comes out of the penis (pre-cum) before orgasm can contain HIV.
  • If you want, put some water-based lubricant inside the tip of the condom.
  • If you are not circumcised, push your foreskin back before you put on a condom. This lets your foreskin move without breaking the condom.
  • Squeeze air out of the tip of the condom to leave room for semen (cum). Unroll the rest of the condom down the penis.
  • Do not “double bag” (use two condoms). Friction between the condoms increases the chance of breakage.
  • After orgasm, hold the base of the condom and pull out before your penis gets soft.
  • Be careful not to spill semen onto your partner when you throw the condom away.
  • Tie the open end of used condom so that the semen does not spill out and disposed off it safely
  1. Condoms: Myths & Facts

MYTH: Condoms break a lot.
FACT: Less than 2% of condoms break when they are used correctly.

DO NOT USE oils, vaseline or creams with latex condoms as lubricant. USE a water-soluble lubricant like KY Jelly.
DO NOT USE double condoms – i.e. one condom over another.
DO NOT USE outdated condoms – i.e. beyond their expiry date.

MYTH: HIV can get through condoms.
FACT: HIV can not get through latex or polyurethane condoms.


The risk of infection from oral sex is believed to be low.

However oral sex has some risk of transmitting HIV, especially if sexual fluids get in the mouth and if there are bleeding gums or sores in the mouth.

Condoms without lubricants are best for oral sex. Most lubricants taste awful.

  1. Chemoprophylaxis (PEP and PREP)

People who have had unprotected sex accidentally – due to condom breakage or failure – or due to oversight or sheer carelessness, and wish to correct their mistake may have some solution to the problem in the form of postexposure prophylaxis (PEP)

The use of PEP, using antiretroviral medications appears to reduce the risk of HIV infection in health care workers following occupational exposure to HIV (eg, needlesticks or other contact with infected blood).

No study has yet quantified efficacy of PEP following sexual exposure to HIV, but nonrandomized studies suggest that PEP may be effective in reducing the risk of HIV infection.
PEP is now recommended for sexual exposures, including sexual assault.
Treatment must be initiated within 72 hours of exposure, and should be followed for 28 days under the supervision of a physician.

The use of anti-retroviral medication administered prior to sexual exposure (pre-exposure prophylaxis, PREP) to reduce the risk of HIV infection is under study in high-risk populations.


Using alcohol or drugs before or during sex greatly increases the chances that you will not follow safer sex guidelines.
Be very careful if you have used any alcohol or drugs.


Some people who are HIV-infected don’t see the need to follow safer sex guidelines when they are sexual with other infected people. However, it still makes sense to “play safe”.

If you don’t “play safe”, you could be exposed to other sexually transmitted infectionssuch as herpes or syphilis. If you already have HIV, these diseases can be more serious.

Also, you might get “re-infected” with a different strain of HIV. This new version of HIV might not be controlled by the medications you are taking. It might also be resistant to other antiretroviral drugs.

There is no way of knowing how risky it is for two HIV-positive people to have unsafe sex. Following the guidelines for safer sex will reduce the risk.

  1. What are the symptoms of HIV?

The only way to determine HIV infection is to be tested. There a period between the person gets infected and the symptoms start showing up. This is the latent period. The latent periods vary from person to person. It is common during the first two to four weeks of infection that people experience flu-like symptoms and enlarged lymph nodes. This is because the virus migrates to various organs in the body, particularly the lymphoid organs. During this stage people are highly infectious and HIV is present in large quantities in genital secretions.

According to the Centers for Disease Control and Prevention, USA, the following are symptoms that may be warning signs of HIV infections:

  • Rapid weight loss
  • Dry cough
  • Recurring fever or profuse night sweats
  • Profound and unexplained fatigue
  • Swollen lymph glands in the armpits, groin or neck
  • Diarrhea that lasts for more than a week
  • White spots or unusual blemishes on the tongue, in the mouth or in the throat
  • Pneumonia
  • Red, brown, pink or purplish blotches on or under the skin or inside the mouth, nose or eyelids
  • Memory loss, depression and other neurological disorders

Remember that the only way to determine HIV infection is to be tested for the virus. No one should assume they are HIV positive or negative based on the presence or absence of any of the above symptoms. Each symptom can be related to other illnesses; similarly, other symptoms or the absence of symptoms cannot assure that someone is HIV negative. To be certain, get tested.

  1. Can I get HIV or AIDS by socialization?

You cannot get HIV or AIDS from normal daily contact with an infected person.

You will not catch it from drinking fountains, cups, glasses, plates, dry cheek kissing, shaking hand or normal interaction in the workplace or school setting. HIV is not an airborne virus.