Avoid unnecessary injections: World AIDS DAY

INVC Bureau

New Delhi. HIV, Hepatitis B and Hepatitis C all can be

transmitted through blood and blood products and or by sexual route.

Though the prevalence of HIV is only 0.3% in the general population

the same of hepatitis C is up to 5%.

Addressing a press conference here on the occasion of World AIDS Day

Dr Naresh Chawla President, DMA, Dr Ashwini Dalmiya Secretary, DMA and

Dr KK Aggarwal President, Heart Care Foundation of India said that

getting injections from unqualified health care workers can spread HIV

/ AIDS.

NACO and the National Institute of Medical Statistics (a body under

ICMR) 2006 estimates suggest national adult HIV prevalence in India is

approximately 0.36 percent, amounting to between 2 and 3.1 million

people. If an average figure is taken, this comes to 2.5 million

people living with HIV and AIDS; almost 50 percent of the previous

estimate of 5.2 million.

More men are HIV positive than women. Nationally, the prevalence rate

for adult females is 0.29 percent, while for males it is 0.43 percent.

This means that for every 100 people living with HIV and AIDS (PLHAs),

61 are men and 39 women.

Prevalence is also high in the 15-49 age group (88.7 percent of all

infections), indicating that AIDS still threatens the cream of

society, those in the prime of their working life.

While adult HIV prevalence among the general population is 0.36

percent, high-risk groups, inevitably, show higher numbers.

Among Injecting Drug Users (IDUs), it is as high as 8.71 percent,

while it is 5.69 percent and 5.38 percent among Men who have Sex with

Men (MSM) and Female Sex Workers (FSWs), respectively.

The spread of HIV in India is primarily restricted to the southern and

north eastern regions of the country. In India the main factors which

have contributed to its large HIV infected population are extensive

labor migration, low literacy level in certain rural areas resulting

in lack of awareness and gender disparity.

Transmission

In order to pass HIV from one person to another, HIV-infected internal

fluid from one person needs to get into the bloodstream of another

person. HIV is usually transmitted through: Sharing needles,

unprotected anal, vaginal, and sometimes oral sex, and from mother to

infant before or during delivery and while breast-feeding.

HIV can spread through unprotected sexual contact with multiple

partners, blood products, mother to baby (before or during, or through

breast milk) and sexual intercourse (vaginal and anal). In the

genitals and the rectum, HIV may infect the mucous membranes directly

or enter through cuts and sores caused during intercourse (many of

which would be unnoticed). Vaginal and anal intercourse is a high-risk

practice.

The mouth is an inhospitable environment for HIV (in semen, vaginal

fluid or blood), meaning the risk of HIV transmission through the

throat, gums, and oral membranes is lower than through vaginal or anal

membranes. There are however, documented cases where HIV was

transmitted orally, so we can’t say that getting HIV-infected semen,

vaginal fluid or blood in the mouth is without risk. However, oral sex

is considered a low risk practice.

An injection needle can pass blood directly from one person’s

bloodstream to another. It is a very efficient way to transmit a

blood-borne virus. Sharing needles is considered a high-risk practice.

It is possible for an HIV-infected mother to pass the virus directly

before or during birth, or through breast milk. Breast milk contains

HIV, and while small amounts of breast milk do not pose significant

threat of infection to adults, it is a viable means of transmission to

infants.

Effective strategy to prevent HIV?

Becoming educated about HIV and understanding the facts about

transmission are the first, and perhaps most important way to prevent

the spread of HIV.

Abstaining from sex particularly with multiple sexual partners and

needle sharing is the most effective way for people to protect

themselves from HIV and other sexually transmitted diseases. However,

when abstinence is not an option for people, using barrier protection

such as latex condoms (male or female) is the next best thing.

Three stages of prevention:

•    Firstly, everyone should take steps to avoid contracting the infection,

•    Secondly, infected person who does not know that he is infected

should be made aware of his condition through symptoms or thorough

examination and

•    Finally, the already infected persons should be made aware of the

need for prevention of other diseases and be aware that he can infect

others.

The most effective ways to prevent HIV Infection:

•    Not having sex – whether vaginal, anal, or oral

•    Sex only between two mutually monogamous, uninfected partners who

do not share needles or syringes with anyone.

•    Not injecting non prescribed drugs

•    Not sharing needles or syringes for any reason (when injected

illegal drugs, medications, vitamins, or steroid; tattooing; or body

piercing)

•    Not engaging in activities that involve exchange of blood, semen,

vaginal fluids, or breast milk.

Ways to reduce the risk of HIV Infection:

•    Using a latex condom the right way every time during vaginal,

anal, or oral sex.

•    Not using drugs or alcohol, which can impair judgment.

•    Cleaning needles and syringes with chlorine bleach and water if

more effective prevention is not available.

•    Using barrier protection (e.g. latex gloves) when coming into

contact with blood.

1.    A new weapon of war, HIV kanya, HIV blood transfusions after

kidnapping, HIV positive syringes for extraction of money.

2.    On Saturday, April 4 09, 52 year old Johnson Aziga was found

guilty of murder by a Montreal jury for not sharing his HIV status

with sexual partners, two of whom later died from AIDS-related

illnesses. According to prosecutors, this marks the first case in

Canada, and possibly the world, where an HIV-positive individual has

been convicted of murder for failing to inform partners of his status.

Aziga, a former government research analyst from Uganda, was found

guilty. He infected seven women; four other partners did not contract

the virus. The Crown argued that Aziga infected the women with

“‘slow-acting poison’ that destroyed their immune systems … leading to

their cancers and to their deaths.” The sex was not considered

consensual because the women were not aware he was HIV positive.

3.    Infected hepatitis c, hepatitis b and HIV, combined blood is the

most deadly weapon ever possible.

Needle stick injury

1.      The average risk of sero conversion after a needle stick injury is

about 3 per 1000 with no prophylaxis. It is estimated that this risk

is reduced at least 80 percent when post exposure prophylaxis (started

within 3 hours) is administered in a timely fashion. Infection is high

with hollow needle, high bore needle and if the needle is inserted in

the artery or the vein.

2.      Prior to the widespread use of hepatitis B vaccine among health

care workers, the prevalence of hepatitis B virus markers was higher

among health care workers than the general public. In 1991 the

guidelines came that all health care workers be offered hepatitis B

vaccine. Recent studies suggest that this strategy has been highly

successful in reducing hepatitis b virus infection among health care

workers with a 95 percent decline in the incidence of hepatitis B

infection among them.

3.      Hepatitis B virus is the most infectious of the three blood borne

viruses. It gets transmitted by percutaneous and mucosal exposures and

human bites. It has also been transmitted by fomites such as finger

stick devices used to obtain blood for glucose measurements, multi

dose medication vials, jet gun injectors, and endoscopes. The virus

can survive on counter tops for seven days and remain capable of

causing infection.

4.      The prevalence of HCV infection among health care worker is similar

to that of the general population. Testing of health care workers for

hepatitis C virus HCV should be performed after needle sticks, sharp

injuries, mucosal, or non intact exposure to hepatitis C virus

positive blood. The average incidence of sero conversion to hepatitis

C virus after unintentional needle sticks or sharps exposures from an

hepatitis C virus positive source is 1.8 percent (range, 0-7 percent).

Transmission of hepatitis C virus from blood splashes to the

conjunctiva has been described. Hepatitis C virus has been

demonstrated to survive on environmental surfaces for at least 16

hours but not four or seven days.