Risk

• Who is at Risk?
     Routes of Spread
     HIV is Not Spread by
• Symptoms
• Diagnosis

Who is at Risk?

Anyone can become infected with HIV. It is transmitted through unprotected penetrative sex (vaginal, anal, oral) with an infected partner. Transfusion of infected blood and blood products, contaminated needles and syringes can spread infection. An infected mother can pass on the virus to her baby before or 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 the risk of acquiring HIV infection and eventually developing AIDS.

Therefore, there are no "risk groups" but only "risk behaviours". Anyone whose behaviour resembles the following categories is at risk:

• Sex workers
• Homosexuals
• Drug users who use needles
• People who have sex with multiple partners, without protection
• People who have blood transfusions, where the blood has not been tested adequately.
• Spouses of people living with HIV/AIDS
• Babies born to people with HIV/AIDS

Routes of Spread

The virus spreads from one infected person to another. Body fluids like blood, semen and breast milk are the conduits for the virus. However, the concentration of the virus varies in each body secretion. Saliva, for instance has very little. In blood the concentration is high.

The following are the routes of spread:

• Unprotected, penetrative sex with an infected partner.

• Infected needles which are likely to have a smear of infected blood.

• A cut or sore on your body which may come in contact with body fluids of an infected person. (The possibility is high in anal sex).

• Breast Milk.

• Kissing – a small risk.

Kissing such as on the cheek or lightly on the lips does not carry the 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.

• At the dentist: low risk. Precautions required.

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

HIV is Not Spread by

• HIV cannot spread by casual contact such as touching, holding hands, shaking hands, light kissing,

• HIV cannot spread by body contact in crowded public places, working or playing together, using common swimming pools and toilets.

• HIV cannot spread by sharing food, vessels and clothes or eating food cooked by an infected person.

• HIV cannot spread by mosquito and other insect bites.

• HIV cannot be acquired when you donate blood. Just be sure sterile needles are used.

Symptoms

The Major and Minor signs classified by World Health Organization (WHO) are:

Major Signs

• Weight loss greater than 10% of body weight.
• Fever for longer than one month, intermittent or continuous
• Chronic diarrhoea for longer than one month intermittent or continuous.

Minor Signs

• Persistent cough for longer than one month
• General itchy dermatitis (skin irritation)
• Recurrent herpes zoster (shingles)
• Oropharyngeal candidiasis (fungus infection in the mouth/throat)
• Chronic progressive an disseminated herpes simplex infection
• Generalised lymphadenophathy (swelling of lymph gland)

Diagnosis

   
• Tests
   
• The Window Period
   
• Confidentiality
   
• Counselling

All persons must be counselled before going in for HIV testing.

Tests

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): this is the most commonly followed procedure.

Spot test or Rapid tests:

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 and complicated or may take long and hence, are used only for research and academic purposes.

The Window Period

HIV takes 2 to 24 weeks to produce antibodies. This is known as the "window period". During this time the individual is infected and infective but the HIV tests for antibodies are negative. Hence, to be sure, the test should be repeated again 6 months after the last probable contact or exposure to HIV.

Confidentiality

HIV positive persons are being discriminated by family, friends, neighbours, colleagues, employers, and the society in general. Unless an individual is assured confidentiality, she/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 encouraged.

Counselling

Counselling is important before HIV testing. Because of the stigma and because of the mistaken belief that testing HIV positive is tantamount to being close to death most people who are diagnosed as positive believe it is a death sentence. This has even driven people to suicide.

Even in mandatory testing routines, such as health check ups or tests before a major surgery, counselling must be provided if the patient is found HIV positive. Otherwise the patient is completely unable to cope.