It is good that you were able to find someone who was supportive and caring. But I would suggest that you should be careful about the doctor because as of today, there is NO CURE for HIV. Which means no medicine can make an HIV infected person HIV- negative. These kinds of assurances (that a person is cured of HIV) are dangerous because the person may go back to behaviours that are risky to himself or may put others (for example, a regular sexual partner) at risk through unsafe sex. Personally, I would call anyone saying that s/he can make an HIV infected person HIV-negative, a quack or a fraud. One can still provide extremely humane care for HIV without resorting to such tall claims. 

Please also understand that being highly infected with HIV is a vague term. What does it mean? Was the viral load too high? Was the CD4 count too low? Also what were these 33 reports? In 20 years of HIV practice, I have rarely required 33 reports. If we can get the list, we could tell you what was necessary and what was not.

Also, once antiretroviral treatment (ART) is started, the viral load can really come down sharply to show 40% improvement and there could be definite clinical improvement too, but still the treatment will have to be life long. AIDS is not a synonym for death any more. If you got scared after knowing the diagnosis it was probably because you were not properly guided before and after the tests. AIDS is now considered a medically manageable chronic disease, just like diabetes or hypertension, where a person can live a prolonged life of good quality but has to adhere very strictly to drug regimens as there is no cure and one cannot become HIV-negative.

So please don’t be carried away by these false claims. Or at least you should not invite others to join this possible fraud.

- Vinay Kulkarni 

I told him he should ask the company for gloves to wear for his own protection. I also told him he should not recap needles because there is a chance of pricking himself. He said that the company provided gloves but gloves reduced sensitivity and prevented him from finding the vein to put the needle in. He also said that the he had to recap the needle in order to detach the vial.

Is he right? Is it safe to take blood without wearing gloves? Is it possible to find the vein while wearing gloves? Is it not possible to detach the vial without recapping the syringe?

This is not a question of 'right or wrong'. It is about being safe. As a principle it would be safer to use gloves while dealing with needles and blood. But if the source case has no infection there is no need for it to be mandatory. Remember there is little risk of exposure when taking blood samples unless there is any abnormal violent movement by the patient or the technician or others in the room.  

Finding veins with gloves on is a matter of practice and should be encouraged.  

If the needle fitting is lure lock type, it may be sometimes difficult to remove the needle but, still, recapping is not the only solution for that. Statistically, the maximum numbers of injuries occur while recapping, so I would advise avoiding the same.  

One may argue that if done properly taking samples without gloves and recapping the needle are safe so long as no accident happens. But we must remember that accidents occur ‘accidentally’, that is why they are called accidents. So it would be advisable to take precautions.

--- Vinay Kulkarni

The protocol for all hypodermic needle injuries is essentially the same. 

Wash the wound with soap and water (in running water). Do not squeeze or suck the wound. Allow the blood to flow naturally if at all there is bleeding. Apply alcohol at the site of the wound. 

Find out if the person on whom the hypodermic needle was used before it was used on the child is HIV-positive or not. If not, then there are little chances of the child being infected. If the person is infected or is very highly likely to be infected (as per symptoms/risk behaviour) then consider post exposure prophylaxis (PEP) of the child. 

The next step is to ascertain the serostatus of the child. This is to exclude already existent infection. If the test is 'positive' that means the child is already infected and needs no PEP. If the tests are negative then:

• Assess the degree of exposure (was the needle hollow or solid bore used for intravenous purpose, how deep was the wound, how much time elapsed between contact with source case and injury to the child etc).
• In case of exposure with mild to moderate risk start PEP (routine).
• In case of severe risk from exposure use extended regimen of PEP. PEP should be administered under medical supervision and after expert advice.
• Test the child to rule out infection at the end of the ‘window’ period (this is the period of time between a person being infected and the disease showing up in tests)

-- Vinay Kulkarni

Should I continue with this drug? With the current acidity problem I don’t think I will be able to complete the prescribed course. I have skipped the drug for one day on the eighth day to get relief from the acidity problem. I have got DNA PCR and Elisa test done for HIV and both were negative. Please advise me again now that I am taking the drug and have got the tests done. What are the next steps? I have moved from Hyderabad to my hometown Delhi, where I do not want to visit any doctor.

Please refer to my first reply. As I had said, in my opinion you did not need the medicines in the first place. Secondly, you started them late enough for them not to be very effective. Thirdly you are having severe side effects. You may stop the medication. 

As I wrote previously there is no role for DNA PCR/ELISA at this stage except to prove that you were not already infected when the incident occurred.  

To rule out infection please repeat the ELISA after 12 weeks (minimum) of the incident and then forget about it if the test is negative. Seek medical care if it is positive. Follow the instructions I wrote last time.

--Vinay Kulkarni 

This is a relatively common issue and thus needs specific detailed answer. It also hints at some misconceptions. 

Generally post-exposure prophylaxis (preventive treatment) is indicated only when the source is known to be HIV infected. So, it is definitely indicated for professional exposures (such as healthcare providers getting exposed to HIV through, say, needle stick injuries when source is known to be HIV infected, or has very high chances of being infected).  

In non-professional sexual exposures like yours, post-exposure prophylaxis is not indicated though there is a fair chance that the casual partner you had sex with could be infected. But you will not know this unless you test and even if the result is negative this could be because you are in the ‘window period’ when the virus does not show up.  

Why is this? Because (1) The status of infection of the source case is not known.

(2) Even a burst condom is going to provide some protection (3) Chances of sexual transmission of HIV when the skin of the penis is not ulcerated or inflamed due to other sexually transmitted infections is relatively very low (say around 1%) even during contacts with a known infected person (4) By now enough time has passed to take any effective prophylaxis (5) Anti-retroviral medicines are potentially toxic drugs and should not to be taken lightly. 

So what can you do now?

• Do not panic.
• Get yourself tested after the window period is over (at least 12 weeks). At that time also go in for routine tests. There is no need for doing fancy tests such as p24 antigen, DNA PCR or Western blot. If these tests are done early and if they indicate that you are infected (this also needs to be confirmed), then they have some meaning. However, negative results do not rule out infection. So wait till the window period is over.
• Do not have unprotected sex with anybody till you find out that you are not infected.

What precautions should you take next time?

• Condoms break/blast usually for two reasons: they not used properly or are not properly lubricated. Learn to use condoms properly; pay attention to pinching the tip before unrolling on the erect penis.
• Even if you know how to use a condom properly alcohol and desire to have sex is a deadly combination. You may make mistakes under the influence of alcohol. Avoid it.

Some misconceptions

• Chances of your infection have nothing to do with you ejaculating or not.

So steps to be taken now:

• Safe sex till you know that you are not infected.
• Get tested after 3 months
• Take care during future encounters.

--Vinay Kulkarni

Anti-retroviral treatment (ART) is available free of cost, at all government-run ART centres. The cost you mention is perhaps money needed for food, transportation to the ART centre etc. Other people living with HIV/AIDS mostly seek the services of non-government organisations or philanthropists who are willing to give a little money for the extra support. 

Getting in touch with INP+ or positive networks in Belgaum where you live will be useful to you as a family, because they may be giving this support or know of persons who are giving this support. 

More importantly there are many, many people who are able to go to work and lead absolutely productive and qualitative lives because they are taking ART. Which means it is necessary for your father to also take ART if you as a family wish him to continue to work and support you. 

- Magdalene Jeyarathnam

The four fluids that can carry HIV are: semen and pre-ejaculate fluid, blood, vaginal secretions, and breast milk, and the virus can only be transferred when these four fluids come in contact with each other.  

Saliva does not carry HIV, so ordinarily the virus can’t be transferred from an HIV-positive person to an HIV-negative person through oral sex. However, if the person performing oral sex is HIV-positive, has a cut or sore on the inside or around the mouth, and blood from the cut comes in contact with semen or vaginal fluids, then he or she can transfer the virus to the receiving partner.  

Oral sex is not considered a “high-risk” sexual behaviour for HIV-positive people to engage in, but it’s not risk-free, either. My advice: use a condom or dental dam. When used correctly, barriers are one of the most effective ways of preventing sexually transmitted diseases and infections. It’s better to be safe than sorry. (That goes for all people engaging in any sexual behaviour—straight or gay, HIV-positive or HIV-negative.) 

--Padma Govindan 

No, water is not good enough; bleach solution is the best cleaning agent. To clean needles and syringe with bleach, first flush three times with clean water and then three times with bleach, each time leaving it in the syringe for 30 seconds. Then flush three times again with water. Yet I must admit that even this is not 100% safe.

-- Eldred Tellis 

The questions are a bit difficult to answer.

Only estimates would be available on how many people got HIV in Gujarat in 2008-2009, and some data from the National Aids Control Organisation (NACO) website (www.nacoonline.org), but they are all estimates. To get precise figures, each person who got infected would have to be tested and then counted. So this statistic is difficult to come by. Also, the best people to provide even the estimates would be the Gujarat State AIDS Society (0/1 Block, New Mental Hospital Complex, Menghaninagar, Ahmedabad-380 016. Tel: 22685210/22680211-13. email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it and This e-mail address is being protected from spambots. You need JavaScript enabled to view it ).

The best place to get free ART is a government ART centre. Get registered and, if eligible, you would be put on ART as per the national guidelines. (for ART centres in India see: http://www.nacoonline.org/Living_with_HIVAIDS/Download_ART/)

You could also locate a good HIV physician (both scientific and humane) in your part of the country and approach him/her for treatment. ART medications are freely available almost throughout the country now and the costs also have come down drastically.

---Dr Vinay Kulkarni

Please tell me what I can do for betterment of my condition and to prevent my brother from disclosing my HIV status. 

Looks like your brother and his wife have taken over your right to decide to disclose your HIV status. Remember deciding who you wish to tell and how much you wish to tell is your right.

Have you tried a quiet talk with your brother? Quiet is the key here.

If not, you could try talking to him or get someone he respects a lot to talk to him - like a doctor, religious/community head.

If nothing works is it possible for you to live away from him? I am suggesting this because your brother seems to be more vicious when he is drunk.

Stigma and discrimination is still a huge issue to many people living with HIV. Please do identify some networks of HIV-positive people so you have other people from your community you could talk to.

--Magdalene Jeyarathnam