There were many factors that led to the government's decision: globally, PLHA organisations had been advocating for free ART; in early 2001, Indian companies forced drug prices down to about Rs 7,000 per year from more than 10 times that much; that same year, the UN General Assembly Special Session on HIV/AIDS called for additional funding for ART; and in 2003, WHO and UNAIDS declared that lack of access to ART was a "global health emergency" and launched the 3x5 initiative to reach treatment to 3 million people in developing countries by the end of 2005.

--Editor, hivaidsonline.in

I will not say that TB is inevitable in the later stages but the chances that an HIV infected person will have TB are at least five times more than a person who is not infected with HIV.

It can be avoided to a certain extent by general measures such as good nutrition, regular exercise and institution of ART at an appropriate time. Adult TB is usually due to reactivation of an infection which a majority of us already have. If one does not have pre-existing TB, has no exposure to TB, and if the immune status is maintained, then there would be very low chance of getting TB.

--Vinay Kulkarni 

PCR is a highly specific test but requires a highly sophisticated set-up. Chances of contamination in the laboratory may give false positive results. If done at a reliable place, and it is positive, it means there is infection. However, the chances that the test would be positive at the end of 48 hours is about 40% (which in other words would mean 60% infections will not be picked up). The sensitivity increases to about 95% by the end of one month and to about 98% by the end of another month. All positive results need confirmation and negative ones need repeating the test after a specified time period. 

The chances of infection if a used needle is accidentally used for drawing blood depend upon whether the person for whom the needle was used previously had HIV, how much time has elapsed after the previous use (as HIV is an extremely fragile virus and stays alive outside the body for a very short time). As during blood withdrawal hardly any material from the needle is pushed, the chances are minimal. Theoretically, chances of infection if a contaminated needle causes injury are 0.3% (3 per 1000). 

--Vinay Kulkarni 

I am not able to understand the question.

No needle should be reused without proper sterilisation. If properly sterilised, say, by autoclaving or boiling for 20 minutes, it can certainly be reused.

If the question is could that needle have been used earlier by a drug user, then it is most unlikely that a packed, new, single use syringe from a quality manufacturer could be a re-used one.

--Vinay Kulkarni

In boxing he represented the Army in the Inter-services tournament. He swears on his mother that he has NOT indulged in such sex. The Army refuses to accept this. I am fighting on the grounds that boxing is a bleeding game, wet-liquid is the requisite media to infect, and therefore, HIV infection was due to the bleeding sport of boxing.  

Even the court is not inclined to listen to this. They want precedents of HIV infection through sports, particularly boxing.  

Do you have any such incident? If so, kindly provide me, or inform the website names where I can find such information. I am to file the review petition by February 25 so I need it at the earliest.  

There are many ways to acquire HIV infection.

There are many people living with HIV in the armed forces and they could have been infected through sex with an infected partner, transfusion of HIV infected blood, or a healthcare procedure, such as an injection, using a needle or blade that was previously used on an HIV positive person and not sterilised after use.

You may wish to question the right of the army to send home a soldier for becoming infected with HIV. It is illegal to fire HIV-positive people in public enterprises.

You may wish to consult the website of the Lawyers Collective HIV /AIDS Unit

(LCHAU). http://www.lawyerscollective.org/hiv-aids 

--Editor, hivaidsonline.in

HIV is NOT transmitted through sharing food or living together. 

HIV infection can occur through the following routes: 

• Unprotected sex with a person who is HIV-positive
• Blood transfusions, skin grafts and organ transplants from someone who is infected
• From an HIV-positive mother to her baby, during pregnancy, childbirth and breast-feeding
• Sharing unsterilised injection equipment previously used by an HIV-positive person.

 --Editor, hivaidsonline.in

HIV is transmitted through body fluids such as semen, blood and saliva. Any person who has sexual contact with an HIV positive person is at risk of acquiring HIV infection. It doesn't matter whether that person has a cough or does not have a cough.

--Editor, hivaidsonline.in

There is nothing that can guarantee 100% efficacy. It will all depend on how much virus has entered the body, what is the person's immune status at that time, and whether the virus is susceptible to Zidovudine + lamivudine combination (Duovir) 

Having said that, let us remember that the chances of infection after an accidental occupational exposure (for which this Duovir is primarily recommended) or sexual exposure are low (said to be around 0.3% and 1% respectively). These can be further reduced if Duovir is taken as early as possible after the exposure (ideally within hours but certainly not after 48 hours).  

Regarding your second question: How long does the virus stay alive outside the body? Rather than giving duration in minutes and hours I would say that it would be better to remember that the virus is extremely fragile and dies quickly when exposed to dryness, heat, etc. I do not know what you mean by ‘silent cold water’. If washed immediately, the virus would get so diluted in water that there may be no risk of transmission. 

--Dr Vinay Kulkarni 

I had the most harrowing time of my life from doctors (including my family doctor) and medical staff who just would not want to see me or attend to me. They wanted me out of the nursing home or they would call the police/media. My family was very supportive but did not know what to do. They tried finding a place to help me but could not find anything. So despite being very unwell I decided to fly back to Bangkok.  

That is what saved me. I flew to Bangkok alone and admitted myself in a hospital. The doctors here are so great. I told them what I had and they asked my permission to take my blood test again and treated me as if I had just a common cold. No fuss, no stigma, no questions, no discrimination, touching me etc as if I were normal! So different from my Kolkata experience. I was diagnosed with acute pneumonia and treated for it and began to improve. They also educated me about my condition. I was discharged from hospital within ten days and although I had become a skeleton by then, I went to work. I still go to work. The doctors wanted me to continue life just as before. After the pneumonia was cured I had TB for which I have just stopped taking medicines.  

I started my medicines for HIV in February ‘09. My health is improving and I have stopped losing weight, although still thin. Since July my 80-year-old mother is keeping me company here in Bangkok, cooking for me and making sure I eat well. That has been a great help. For now, I seem to be

doing well and can cope with the constant feeling of being tired - so much better than getting up and getting through the day with so much struggle.

However, I really want to go back to Kolkata in the New Year as my job contract in Bangkok is getting over but I am frightened of doing so as I don’t know of any doctor to see or where to go for my medicines etc. Can you please help me in suggesting a doctor/clinic I can go to for my medicines and check up when in Kolkata. Can you also help me get in touch with organisations and groups dealing with or helping people living with HIV/AIDS. I so desperately need a support group.  

I really want to go back to India/Kolkata and definitely do some NGO work so people don’t have to go through what I did. I don’t know where to start.   

For information on organisations in West Bengal, please contact Pawan Dhall, Country Director – Programmes & Development, and Kolkata office

Director, SAATHII (Solidarity and Action against the HIV Infection in India), at 229, Kalitala Main Road, Purbachal (North) Calcutta 700 078, India

Phone: 91-3324844835, 91-3324845002
E-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

You can also contact the State Aids Control Society at the following address: 38 West Bengal State AIDS Control Society Swasthya Bhavan, GN - 29, Sector - V, Salt Lake, Kolkatta - 700091. Contact person, S K Sen 033-23574400, 23570122, 23576000, 23577944 (FC). This e-mail address is being protected from spambots. You need JavaScript enabled to view it ,

- Editor, hivaidsonline.in 

Three weeks after my exposure there were enlarged submandibular nodes, 3-4 on each side, 1-3 cm in size. There was some tingling in the parotid region, but no pain. Week 7 (day 49) I developed a low grade fever and sudden onset of severe pain in my knee joint and muscle aches in my legs. It was quite severe and though I managed to walk about, I was unable to stand for long. There were also pains in smaller joints of my toes and fingers. On movement there were clicking sounds, but no pain in shoulder and wrist joints. I also had pain in the skin of my soles and fingers, a left side tinnitus and weakness in the muscles of my left hand. There was no sore throat, cough or nasal congestion.   On day 10 of illness, my TLC had fallen from my usual count of about 5000 to 4000/mm3. The symptoms more or less subsided in about two weeks but I continued to have joint pains in small joints off and on. I also had on and off muscle aches in my thigh for two months after symptoms began.

I am very concerned that the swollen lymph nodes were due to ARS. I haven’t had a swollen lymph node I know of all of my life and to have several of them in the drainage site of the eye within just three weeks post exposure has me quite convinced they were due to HIV. I also haven’t fallen so ill in almost 20 years.

I’m finding it very hard to believe that my illness is not related to the exposure. However, I had negative antibody tests on three occasions after this illness - a 9.5 week combo test for HIV 1/2 and p24 (which corresponded to 18 day after symptom onset), a 12 week 3rd gen ELISA (35 days after symptom onset) and a 19 week combo test and a rapid immunogold comb test (12 weeks after symptom onset). All done in a well reputed private lab. My relief after each negative has been very   short-lived, just a couple of hours or a day at the most.

I have come across the UK national screening and testing guidelines.(http://www.guideline.gov/summary/sum...x?doc_id=12376). I am quite concerned about the last paragraph under the heading ‘Negative test results’ which states: ‘If a patient presents with clinical symptoms suggestive of HIV infection or acquired immunodeficiency syndrome (AIDS) and the HIV screening tests are repeatedly negative, then referral of the specimen to a specialist testing unit is recommended.’

I’m concerned that NACO recommends testing up to the six month for occupational exposures. Please guide me and give me your valuable opinion regarding my HIV status. Can I rely on a 19 week negative since I haven’t taken PEP? Do you think I require further testing or specialist testing? I’m not on any immunosuppressant therapy or a drug user and have had no major health problems. I’m quite upset that specialist testing would involve PCR and Western Blot that are known to give false positives and indeterminate results. If I do get a PCR and Western Blot, what are the chances of getting false positive and indeterminate results? I do think the virus is there; I may be a rare case that hasn’t made antibodies, or the antibodies are not directed to the antigens used in ELISA tests.  

This is a tricky situation. Let us go one by one.

The exposure was a very low risk exposure. It is your anxiety that is making you more worried. If you washed your eye immediately, that is good enough. You did not take PEP and that is also okay (though some others may differ on this; in a similar situation, I would not have taken or suggested PEP).  

Now, the symptoms. They may suggest acute HIV infection or may not. Just because you never had something in your life before does not mean you will not get it ever due to anything else. The fall of TLC from 5000 to 4000 does not make any sense as both are normal. I do not know a single person who could say that my normal TLC is 5000. Because there are diurnal variations and anything within normal range is normal. Many things may lead to temporary decrease, not only HIV, so that again does not tell us whether it was HIV or not. 

What do we do now? 

The only way to know is by doing a test. A negative test after more than four months reasonably rules out infection. If you repeat it at the end of six months be sure that you are not infected (as you may keep on attributing everything happening to you in future to HIV and would keep on getting anxious, especially when you have generally been healthy).

I will not suggest any other test but our standard ELISA/Rapid/Simple tests. No need to go in for more sophisticated ones such as DNA PCR. I would also recommend you not pull out your hair by surfing the internet. Instead take the opinion of a good HIV physician in your vicinity.  

So, at best, I suggest another test at the end of six months of exposure and if it is negative, just forget about it.

--Vinay Kulkarni