FAQ’s on adolescence and AIDS

This part of the website attempts to answer questions that young people frequently ask about reproductive health, sexuality and HIV/AIDS.

Source: NACO Hand Book for Young People

Growing Up!

Facts About HIV/AIDS Transmission

Treatment

Prevention

Condoms for Prevention

HIV Symptoms

HIV and Young Women

Responses to HIV/AIDS

Growing Up!

Q1. What is Puberty?

Puberty is a time when the bodies of boys and girls physically change, bodies grow bigger and taller, genitals mature, and hair often starts to grow in different places on the body. A girl becomes physically able to be pregnant after puberty and a young boy becomes physically able to father a childafter onset of puberty.

Q2. What are the reasons for changes that occur in the body during teens?

These changes happen because of changes in the natural chemicals in the body called hormones. Both boys and girls have hormones but they have different amounts of different hormones. That is why some of the changes that take place are different for girls and boys.

Q3. Is it normal for some boys and girls to mature earlier than others?

Yes. Some boys start puberty as early as 10 years old, others not until they are 14 or 15 yrs old. Some girls start puberty as early as age eight, others not until they are 13 or 14 yrs old. However, if a girl does not start menstruating by the age of 16, she should consult a health provider.

Q4. What is menstruation?

Menstruation is the monthly discharge of blood and tissue matter that develops on the inner lining of uterus in preparation of receiving a fertilized egg. A young girl between the age of 10-15 years starts producing a mature egg each month through her ovaries. When this mature egg does not get fertilized, the uterus which had been preparing for this, starts discharging the developed tissue and blood through vagina. All this is regulated by the hormonal system, which in turn may affect energy levels and moods. This is why sometimes before and during periods, some women may experience mood changes, pain and tiredness.

Q5. Is Menstruation (Period) something dirty or an illness?

Having the period does not make women abnormal, ill and dirty at all. It is totally normal for every woman to have menstruation. There is no reason why they should not bathe, eat pickle or ice cream, play games, wash their hair, or do other things during their periods. Moreover, due to regular loss of blood, women need to supplement their diets in order to protect themselves from any nutritional deficiencies. Menstruation gives women the power to reproduce or procreate so it is in no way dirty!

Q6. What are the reasons for pain during menstrual period?

The lining of the uterus, which was ready to receive a fertilized egg, breaks down if there is no fertilized egg to settle down. The muscles of the uterus start to contract in order to move the lining of the uterus towards the opening of the vagina. These contractions of the uterus cause pains such as stomach ache and back ache during menstruation. If these pains are very strong, one loses a lot of blood or if the periods continue for more days than usual, one is advised to see a doctor or a health worker.

Q7. Is there any problem due to irregularity in menstrual cycle?

When a girl starts to get her periods, it may take sometime to get regular. Also sometimes her menstrual cycle may become irregular as her periods may be delayed or occur earlier than expected because of illness or mental tension like stress. Irregularities in the menstrual cycle are quite common amongst young girls who have just begun to menstruate. However, if you do not menstruate or if you are worried, you are advised to see a doctor or a health worker. A missed period is usually one of the first signs of pregnancy if a girl or young woman is sexually active.

Q8. What is the right length of a penis?

There is no standard penis size, shape, or length. Some are fat and short. Others are long and thin. There is no truth to the idea that a bigger penis is a better penis. Also the size of the penis has no relation to body size. Penile size cannot be increased by exercise, massage, or medicine. Also, repeated sexual intercourse does not lead to increase in the length of the penis.

Q9. What is a Wet Dream?

A wet dream (or nocturnal emission) is when a boy's penis becomes erect, and he ejaculates while sleeping. This causes the boy's clothes or the bed to be a little wet when he wakes up. The fluid contains sperm and is mucus-like, sticky and whitish. This does not lead to any kind of weakness in boys. Also the fluid, which comes out, is not blood.
A boy cannot stop himself from having wet dreams. Wet dreams, do not indicate that a boy has had sex with a girl before. Even thinking or hearing about girls and sexual relationships may result in a wet dream. Also, having wet dreams does not mean that the boy has to have sex with a girl.

Q10. How does wet dream influence a boy's health and fertility?

If a boy does not know about wet dreams, he could be worried or confused. Wet dreams are completely natural and normal. They do not negatively influence the boy's capacity and capability to produce sperms in future. The male body makes sperm continuously throughout its life.

Q11. Why does one get more sexual desires during adolescence?

This is something natural. At this time the body starts becoming more mature and preparing itself for future. Along with changes in body size and shape, there are also changes in the hormones. Growing up means that our ideas and interests also begin to develop and change. We become more conscious of ourselves, our bodies, our feelings and want to feel more 'grown up'. We also start getting attracted to people, notice how they look, wonder if they will pay any attention to us and want to be noticed by them.

However, these feelings do not mean that one should start having sex. Talking and thinking about sex and actually having sex are totally different things. Talking about sex is totally normal for adolescents and involves no health hazards. On the other hand, having unprotected sex can lead to unwanted pregnancy or being infected with a sexually transmitted infection, including HIV/AIDS.

An adolescent has to make sure that no one forces him/her into having sex. Similarly one should not pressurize others to have sex on grounds of love, friendship etc. When one feels that the time for having sex has come, the person should make sure to protect oneself and the partner from unwanted pregnancies, STIs and HIV.

Q12. Does the ability to reproduce and have a satisfactory relationship depend upon the length and shape of the penis?

Penile size and shape is not important for sexual satisfaction and does not affect the ability to reproduce. During sexual intercourse the question of penis size and shape is not the most important one, what is important is that both man and woman are in good health and that they have a caring relationship. The most sensitive sexual part of a woman is not inside the vaginal canal but on the outer one third area of the vagina.

Q13. What if a man or woman wants to have sex and the other person does not?

Sex should be a pleasurable and consensual act between two people. A man or woman should never be forced to have sexual intercourse or do anything else with his or her body that he or she does not want to do. A person must offer his or her permission before letting anyone touch him or her. If a situation arises in which someone is inappropriately touching another person without permission, the person should seek help immediately.

Q14. Boys in their teens have increased desires of spending time with girls. Is it normal?

It is a very natural part of growing up that adolescents or teenagers start to develop an interest in peers of the opposite sex. It is also normal that they start to talk about love and sexuality. Adolescence is the time they can inform themselves about sexuality, about what goes on in their body and their mind, as well as in the mind of others. During adolescence they can have a sound friendship with other peers, based on mutual respect, trust and honesty.

Q15. What are the reproductive and sexual organs of girls and how do they function?

The vagina, uterus (womb), the ovaries and the fallopian tubes are the internal reproductive organs and the external organs include the vulva(labia majora and labia minora), the clitoris, opening of the urethra, the vaginal opening and the breasts.
A girl's genitals (vulva) are not clearly visible because they lie within folds of skin. What is visible is the outer part, which in the teen years begins to get covered by hair. This hair is called pubic hair and is usually thick and curly.
In girls there are two different openings. The urinary opening, from which liquid wastes are removed in the form of urine, is within these folds of skin. Just below this is another opening called the vagina or vaginal passage. When one starts to menstruate this is from where the menstrual fluids come out. This is also from where babies come out.
Just above the urinary opening is the clitoris. It is a tiny structure hidden within the folds of the inner lips where they join. It is extremely sensitive to touch and becomes firmer and slightly bigger on stimulation .
The vaginal passage is elastic and muscular. The body produces a fine liquid to keep the walls of the vagina moist, healthy and clean. The liquid is present in very small amounts so most of the time one does not feel it. But sometimes, especially when a girl/woman is excited, she might feel the liquid or feel some wetness. This is normal. It is also normal that this part of the body has a particular smell. As long as a girl keeps herself clean (e.g. daily bath, etc.) the smell is not dirty or offensive.
The vaginal passage leads to the uterus or womb inside the body. This is where a baby grows in its mother's body. On either side of uterus is an ovary. These are two small almond-shaped structures. The ovaries contain thousands of little eggs from the time a girl is born. Boys do not have uterus or ovaries-that is why they cannot have babies. As a girl grows older her breasts begin to develop. The tips of the breast are called nipples. The sexual organs may differ in size, shape and colour from one girl to another.

Q16. What are reproductive and sexual organs of a boy and how do they function?

The penis, seminal canals, the urinary canal, the bladder, the seminal vesicles and the testicles (testes) are the internal and external reproductive and sexual organs.
Boys have a penis and two testicles below the penis. The two testicles or testes may not be of equal size and one testicle may hang slightly lower than the other. The penis may be tilted towards either the left or the right side of the body. It is usually slightly curved at the tip. The tip of the penis has a small opening for the urine as well as the sexual fluid (called semen).
The outer layer of skin covering the penis is the foreskin. The foreskin should gently be pushed back while having a bath so as to clean off the whitish sticky substance that collects below it. In some communities people remove the foreskin during childhood. This is called circumcision.
When a boy is sexually excited, his penis becomes hard and erect. This is known as an erection. The sexual organs in boys may differ in size, shape and colour from one boy to another.

Q17. What is an Erection and why does it happen?

Erections occur when a nerve centre at the base of the spinal cord sends out messages that bring blood rushing into the three spongy reservoirs in the penis. Penis fills with blood and becomes hard and straight. Erection happens sometimes as boys fantasize and think about sexual things, or sometimes for no reason at all. It is very common for boys to wake up with an erection in the morning. This is completely normal and healthy. Having erections is not a sign that a boy needs to have sex.

Q18. What do you mean by ejaculation?

It is something involuntary, not something one can control directly. It is something that "happens". In an ejaculation, semen comes spurting out of the penis that pushes the semen out at the peak of sexual excitement. This semen comes through the urethra, the same opening from which, the urine comes out. But there is no chance of any urine coming out during an ejaculation. During ejaculation, a sphincter, or valve, around the duct leading from the bladder tightens and shuts, and urine gets blocked.

Q19. Why do young people have sex?

Young people have the desire to feel grown up and peer pressure makes them anxious not to miss the "right moment". Young people have sex maybe from a desire for intimacy or pleasure, for fun or curiosity or because of feeling in love. But often it can be for other kinds of complicated reasons. Maybe they think it is the thing to do, or feel pressure from friends or the media or are under the influence of alcohol or drugs. Girls can end up having sex simply because they are unable to say "NO", are afraid to lose their partner or, want to please their boyfriend. Boys can do it just to boost their sense of value to other boys, for a feeling of control over women or in order to please their girlfriends.

Q20. If one does not have sexual intercourse for a long time, does it lead to any damage or sickness?

The truth is that there are no health problems at all if one abstains from sex for a long time. No harm will be done to either private parts or any other part of the body. And, if a man or a woman starts having sex again after a long time, he or she will feel enjoyment and excitement as before. One can be sure that not having sex is totally safe. But having unsafe sex can lead to unplanned pregnancy, sexually transmitted infections and HIV/AIDS.

Q21. Can a girl get pregnant during her periods?

Yes, it is possible although not common. It depends on the length of her cycle, how many days her period lasts, and when she has sexual intercourse, because the sperm can stay alive up to two days in the body.

Q22. What determines whether the baby is a boy or a girl?

When a human egg is fertilized with sperm, the sex of the baby is determined immediately. Sperms and eggs contains "chromosomes". There are two types of chromosomes - either an X or a Y. If the sperm contains a Y chromosome, the child will be male; if it contains only an X chromosome, the child will be female. The man's sperm determines whether the baby is a boy or a girl. A female child would have XX chromosomes and male child would have XY chromosomes.

Q23. Does a woman always bleed when she has sex for the first time?

No. Some women bleed when they have sex for the first time; others do not. The hymen of girl may get damaged while cycling, playing, exercising etc. Absence of bleeding the first time one has sexual intercourse is not a sign that one is not a virgin.

Q24. What is white discharge? Is it harmful?

Once women have begun menstruation, they may notice that a small amount of whitish sticky fluid comes out of their vagina at certain times of the month. This is normal as long as it does not feel itchy or stain the undergarments or have a horrible smell.

Q25. What leads some people to be abnormal and be homosexual?

First of all, there is nothing wrong with being homosexual. There are no clear biological answers to why people are gay or lesbian. Homosexuality can be found in children of both married heterosexual parents, divorced, multi racial and single parents so there is no relationship between parents and ones sexuality and the same applies to factors, such as one being closer to ones mother or father. Homosexuality is not a mental disorder and many psychologists oppose all portrayals of lesbian, gay and bisexual people as mentally ill and in need of treatment due to their sexual orientation.

Q26. Can homosexual orientation lead to acquisition of HIV infection?

No. Mere homosexual orientation itself will not give HIV infection. Only when it is practiced with an infected person without condom there is the chance of getting HIV, such as having anal sex without condoms. The risks of sexually transmitting HIV between lesbian women are very low. Very few women are known to have passed HIV on to other women sexually. Oral sex is low risk- but there is increased risk if woman has cuts or sores on her mouth, or her partner receiving oral sex has sores on her genitals or is having her periods.

Q27. I have been hearing the term sexuality education? What does it include?

It emphasizes a broad approach to sexuality, focusing on the individual and presenting sexuality as a natural and positive part of life. It covers all aspects of becoming and being a sexual, gendered person and includes biological, social, economic, and cultural view points. It explores values and develops social skills with the goal of promoting health. The goal of sexuality education is to promote reproductive health and enable young people to understand why they need to act responsibly in matters of sex including delaying and abstaining wherever possible.

Q28. At what age should young people receive education on sexuality?

The education on sexuality has to be age appropriate, however, there is no defined age for teaching children about sexuality. One can start with body changes and growing up concerns that in some countries is shared with the young people as early as eight to nine years. This can be followed up with other aspects of sexuality like attraction towards opposite sex, relationships, and sexual activity as the adolescent grows older.
Contrary to popular belief, extensive research shows that children are most likely to delay sexual activity and practice responsible behaviours if they learn about relationships, and sexuality before they reach puberty.

Q29. From where do young people obtain information related to sexuality?

The mass media is probably the most popular source of information for young people seeking knowledge about sexuality. Throughout the developing world, increasing access to television, radio, books, popular magazines, has enabled the mass media to emerge as one of young people's most common sources of information about sex and sexuality.
A large number of young people get information on sexuality solely from their peers, or media. Such information could be inaccurate, incomplete or portray stereotypes.

Q30. How can one talk to parents on issues of sexuality? They get upset and reject such questions.

It is challenging however, one should try! If parents get upset when asked these questions one needs to realise that parents come from a mind set or belong to a social cultural environment where the topic of sexuality is a taboo. It may not work the first time, so one should not have high expectations right away. But remember that young people do have the power and ability to create a new adult relationship with them. This definitely takes a big effort on one's part, but it will be wonderful and worth trying.

Q31. What are the signs or symptoms of an STI in a man?

Men may experience painful urination, urethral discharge, ulcers, or sores, depending on the STI. They should seek treatment as soon as possible if they have any of these symptoms.

Q2. What are the signs or symptoms of an STI in a woman?

Women may experience genital sores or ulcers, lower abdominal pain or tenderness, unusual vaginal discharge, vaginal itching, painful urination, or painful sexual intercourse, depending on the STI. In girls and women the STIs may remain without symptoms for a long time. They should seek treatment as soon as possible if they have any of these symptoms.

Q32. What are the signs or symptoms of an STI in a woman?

Q33. What are the names of common STIs?

Syphilis, chancroid, gonorrhea, chlamydia, genital herpes, trichomoniasis, hepatitis B, human papilloma virus (HPV), and HIV are some of the common STIs.

Q34. Is it possible for a person to have an STI and not know it?

Yes. STIs in women commonly go untreated because they are often asymptomatic. This means that signs or symptoms are not experienced even though the infection is active.

Q35. How can I protect myself against STIs?

The only methods for protecting oneself against STIs are engaging in a monogamous relationship, practicing abstinence or using condoms. If you do contract an STI, it is important that you see a health provider in order to treat the infection with medicine.

Q36. Can one get an STI from any kind of sexual activity?

STIs are spread via sexual contact, which includes sexual intercourse and anal or oral contact.

Q37. Can there be serious long-term health problems when a person contracts an STI at a young age?

Yes. Some STIs cause permanent infertility, chronic pain, and cancer of the cervix. Without treatment, heart and brain damage can develop 10 to 25 years after initial exposure to STI like syphilis.

Q38. Is it possible to prevent pregnancy and STIs at the same time?

Yes. A couple can use the male or female condom to protect against both pregnancy and STIs, including HIV. A couple may also use two contraceptives (for example, a condom and oral contraceptive pills) to protect against both pregnancy and STI/HIV transmission. Lastly, the surest form of protection from unintended pregnancy and infection can be achieved through abstinence, the avoidance of sexual intercourse altogether.

Q39. Does sexual intercourse during the menstrual period increase the risk of acquiring STI or HIV?

Yes, women are more vulnerable to STI & HIV infection during their menstrual period because of changes in the vaginal micro-environment. The presence of blood during menstruation facilitates transmission of HIV & STI infection if she has sex with an infected partner during menstruation.

Q40. Does sexual intercourse with a person having STI increase chances of HIV infection?

Yes, STIs facilitate HIV transmission either by increasing HIV susceptibility or HIV infectiousness or both. Every STI causes some damage to the genital tract, which facilitates the entry of HIV into the body. The most common STIs implicated in HIV transmission include Syphilis, Chancroids, Genital herpes and Gonorrhoea.
Early treatment of STI reduces the risk of spread to other sexual partners and also reduces the risk of contracting HIV from infected partners. Besides, early treatment of STI also prevents infertility and ectopic pregnancies (where the pregnancy takes place in the fallopian tubes instead of the uterus).

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Facts About HIV/AIDS Transmission

Q41. Why this disease is named as AIDS?

AIDS is

A- Acquired
I - Immuno
D- Deficiency
S - Syndrome

ACQUIRED, because it is always acquired from an external source. IMMUNO DEFICIENCY, because the virus destroys the body's "Protective Mechanism" (Immune System) and causes weakening of the immune system that fights against diseases; and SYNDROME, because people in advanced stages of AIDS are attacked by a number of diseases and they have multiple symptoms of weakened immune system.

Q42. How does infection with Tuberculosis(TB) affect the HIV/AIDS scenario?

A tuberculosis bacterium is a strong drug resistant microorganism. It kills nearly 30 lakhs people globally, of whom nearly 50 percent are Asians. The rapid spread of HIV in the region has further complicated the already serious situation.
TB is the commonest life-threatening opportunistic infection among people living with HIV in India, and the incidence of TB has now begun to increase, particularly in areas where HIV prevalence is high. Multi-drug resistant TB is also quite common in many areas. TB shortens the survival of patients with HIV infection and accelerates the progression of HIV to AIDS. Effective treatment not only prolongs the survival of patients living with HIV, but also improves their quality of life.

Q43. Is HIV/AIDS contagious?

HIV is not spread through ordinary social contact; for example by shaking hands, travelling in the same bus, eating from the same utensils or by hugging. Mosquitoes and insects do not spread the virus nor is it water-borne or air-borne. HIV is transmitted mostly through semen and vaginal fluids during unprotected sex with an infected partner. Besides sexual intercourse, HIV can also be transmitted in the following ways: sharing of contaminated (with infected blood) needles; by the transfusion of infected blood or blood products; and from an infected woman to her baby before birth, during birth or after delivery.

Q44. What are the activities which do not transmit HIV infection?

HIV infection does not spread through:

Physical contacts such as shaking hands,
sharing cups, etc with an infected person
Travelling with an infected person
Mosquito bites
Using public toilets, swimming pools, community showers
Caring for people living with AIDS.

There has never been a case where a person was infected by a household member, relative, co-worker, or friend through casual or everyday contact. Sweat, tears, vomit, faeces, and urine do contain HIV, but have not been reported to transmit the virus. Mosquitoes, fleas, and other insects do not transmit HIV.

Q45. Does tattooing or pricking of ears and nose spread the HIV infection?

A risk of HIV transmission does exist if instruments contaminated with blood are either not sterilized or disinfected and are used inappropriately between clients. It is always recommended that instruments that are intended to penetrate the skin be used once, then disposed of or thoroughly cleaned and sterilized. People who do tattooing or body piercing should be educated about how HIV is transmitted and what precautions can prevent transmission of HIV and other blood-borne infections in their settings. If you are considering getting a tattoo or having your body pierced, find out what procedures are used to prevent the spread of HIV and other blood-borne infections, such as Hepatitis B virus.

Q46. Can kissing transmit HIV infection?

There are no reported cases of people getting HIV from deep kissing. It might be risky, however, to kiss someone where there is a chance for blood contact when the HIV infected person has an open cut or sore in the mouth or on the gums. It would be even more risky if both people had bleeding cuts or sores.

Q47. Does intake of semen lead to AIDS? Can oral sex lead to acquisition of HIV infection?

It is possible to become infected with HIV through oral sex. There have been a few cases of HIV transmission from performing oral sex on a person infected with HIV. While no one knows exactly what the degree of risk is, evidence suggests that the risk is less than that of unprotected anal or vaginal sex.
Blood, semen, pre-seminal fluid, and vaginal fluid all may contain the virus. Cells in the mucous lining of the mouth may carry HIV into the lymph nodes or the bloodstream. The risk increases if the person has cuts or sores around or in the mouth or throat; if the partner ejaculates in the mouth; or if the partner has another Sexually Transmitted Infection.

Q48. Can premarital or extramarital sex lead to HIV infection?

Any unprotected sex whether premarital, or extramarital can lead to HIV infection if either of the partners already has HIV infection. If either partner has had unprotected penetrative sex (intercourse without a condom) with another man or woman who may have multiple sexual partners, the risk is real.

Q49. Is AIDS supposed to be a "gay disease"?

No. This idea came up because the first few patients found with AIDS were homosexual men. But they got AIDS not because they were homosexual, but because they had unsafe sex with each other, and the virus spread from one to many. Many people are still prejudiced against homosexuals. However, nowadays, the people who seem to be getting AIDS the most are those involved in male-female sexual activities, i.e., heterosexual transmission.

Q50. Are there any chances of getting HIV at very first sexual intercourse?

Yes. There are chances of getting infected with HIV at the very first sexual intercourse provided one of the sexual partners is already infected. There have been instances where one contact with sex workers by young men under pressure from friends lead to HIV infection.

Q51. Can we get HIV after the age of 40 years?

Age has nothing to do with acquiring HIV, it has lots to do with behaviours. Anybody like men/women or young/old can get HIV/AIDS through the various routes of transmission.

Q52. Do bisexual people get HIV?

"Bi-sexual" is a person sexually attracted to, and interested in forming romantic relationships with both males and females. If a bisexual person has multiple sexual partners of both sexes and has unprotected sex, there will be a high risk of his/her getting the HIV infection.

Q53. Does the urine or stools of an infected person transmit HIV infection?

Although it has been confirmed through research that HIV is present in the urine or stool of an infected person, it has also been established that the concentration of HIV is so low that there has not been any reported case of HIV infection through these fluids.

Q54. How is HIV transmitted from mother to child?

An HIV-infected mother can infect the child

During pregnancy(while in the womb through placenta)
During child birth( labour or delivery)
During lactation (breastfeeding)

Anti Retroviral Drug (ART) if taken by infected pregnant women can reduce rates of transmission. Effectiveness of this therapy increases if HIV is diagnosed early during the course of pregnancy.

Q55. Do children get HIV/AIDS?

Around 90 percent of children contract the virus by mother to child transmission. Children can also be infected via blood/blood products if these are not screened for HIV and by contaminated needles. Also, there are many reported cases of children or adolescents in the age of 10-19 years who have contracted HIV through injecting drugs and through unprotected or forced sexual intercourse with an older infected person.

Q56. If I am infected with HIV, then can I have sex without a condom with a HIV positive person?

The Human Immuno Deficiency Virus is more than one type. You and your partner have very different immune systems and you cannot assume you both have exactly the same type of HIV virus. It is possible to get infected with an HIV strain that is more aggressive than the one you have, or with one that might be resistant to the medicines you are currently taking. Either way, becoming "super infected" could indeed have a negative effect on your health. Of course, there's always the risk of other STIs as well. The bottom line is there is a risk; that risk has been scientifically documented. Only you and your partner can decide if this is a risk the two of you are willing to take. But for your safety, it is always better to use condoms when you have sexual intercourse.

Q57. How to avoid transmission of HIV from one infected person to his or her non infected partner?

If either of the partners is infected, consider other activities such as kissing or embracing instead of penetrative sex. If this is not possible, use a condom continuously throughout sexual intercourse and consistently each time you have sexual intercourse.
Do not donate blood
If a woman is HIV-infected and wishes to have a baby, then she should take medical advice and if possible take ARVs to minimize the risk of transmission to the unborn baby
If one of the sex partners contracts an STI, both individuals should receive treatment for the STI and consider being tested for HIV

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Treatment

Q58. Why can AIDS not be cured?

The two obstacles to finding a cure are:

The HIV virus can "hide" dormant in cells where it is beyond the reach of HIV drugs; and
HIV vaccines to date have not proven effective.

Q59. How long will it take to develop a vaccine against HIV/AIDS?

Despite continued intensive research, experts believe it will be at least a decade before we have a safe, effective, and affordable vaccine against HIV. Even after a vaccine is developed, it will take many years before the lakhs of people at risk of HIV infection worldwide can be immunized. Until then, other HIV prevention methods, such as practicing safe sex and using sterile needles and syringes, will remain essential.

Q60. Can AIDS be cured by total replacement of blood?

No, blood transfusion will not cure AIDS since…

It is not possible to replace the entire blood of human beings
Even if you are able to replace the blood, HIV is present in other organs of human body as well, such as brain, genitals, liver, spleen, kidneys, bone marrow, cerebrospinal fluid and breast milk.

Q61. What is the life span of a HIV positive person?

Life span of a HIV positive person depends on factors such as:

Immunity or the ability to fight against diseases
Viral load (the amount of virus in the blood or body tissue)- more the viral load less is the immunity of the body.
Life style of a person - healthy food (contains good nutrition) habits and exercises helps in sustaining immunity
Avoiding stress and intake of alcohol, tobacco, and drugs

The available scientific evidence suggests that without treatment 85 percent of HIV infected people may live upto 10 years before developing AIDS, 10 percent may live beyond 10 years and 5 percent may live only 5 years.

Q62. Are there any treatment centres for HIV clients?

Treatment for most of the opportunistic infections of people living with HIV is available at all government hospitals. Apart from these there are several NGOs, which also provide care and support services.

Q63. Why should one maintain confidentiality about the HIV status of an individual?

People living with HIV/AIDS have a right to live in dignity. It is their Right to decide to disclose or not to disclose their HIV status. Many people living with HIV have faced discrimination once they have disclosed their HIV status. One should maintain confidentiality about the HIV status of an individual so that they don't face any stigma or discrimination from other people.

Q64. What are the drugs available for HIV positive people and how do these work?

Anti-HIV (also called antiretroviral, ARV) medications are used to control the reproduction of the virus and to slow the progression of HIV-related disease. Highly Active Anti retroviral Therapy (HAART) is at present the recommended treatment for HIV infection. HAART combines three or more anti-HIV medications in a daily regimen. Anti-HIV medications do not cure HIV infection and individuals taking these medications can still transmit HIV to others.

Q65. Can HIV be detected immediately after entering the body?

The antibodies can take three to six months to show up in a person's blood. The most commonly used test to find out if a person is infected with HIV looks for the antibodies to the virus. Antibodies are produced by the immune system to fight the virus. The time immediately after infection is known as the window period. During this time, an HIV test may be negative because the body has not started to produce antibodies against HIV. An HIV infected person can transmit virus during this window period. However, it is important to consistently reduce the risk, by refraining from any unprotected sex and/or the sharing of unsterilized needles during the window period. If a person thinks that he/she may have been exposed to the HIV virus through unprotected sex or the sharing of unsterilized needles, then he/she should go for counselling or visit a doctor. There are Voluntary Counselling & Testing Centres (VCTC) that can give you the correct information on testing & the safe behaviour that you would need to follow.

Q66. What is meant by ELISA?

When the body is infected with HIV, it produces antibodies specific to HIV. The test, called ELISA (Enzyme Linked Immunosorbent Assay), looks for such antibodies in blood. If antibodies are present, the test gives a positive result. A positive test has to be confirmed by another test called Western Blot or Immunoflouroscent Assay (IFA). All positive tests by ELISA need not be accurate and hence Western Blot and repeated tests are necessary to confirm a person's HIV status. A person infected with HIV is termed HIV- positive or seropositive. If a person is highly likely to be infected with HIV and yet both the tests are negative, a doctor may suggest a repetition of the tests after three months or six months when the antibodies are more likely to have developed.

Q67. Where can I get tested for HIV?

Many places provide testing for HIV infection. Common testing locations include local government tertiary hospitals, some district hospitals, offices of private doctors, and sites specifically set up to provide HIV testing and counseling. It is important to seek testing at a place that also provides counseling about HIV and AIDS. Counselors can answer any questions you might have about risky behaviour and the ways you can protect yourself and others in the future. In addition, they can help you understand the meaning of the test results and describe what services and resources are available in the local area.

Q68. How can you know whether a partner has an HIV-infection before marriage?

HIV status of a person can be ascertained only by a blood test. One should go for HIV test if the person has had a history of high risk behaviour. Moreover HIV testing is voluntary so no one can force or should be forced to undergo the test.

Q69. What if I test positive for HIV?

Post test counselling is available at VCTCs and with some NGOs. If you test positive for HIV, the sooner you take steps to protect your health, the better. Early medical treatment and a healthy lifestyle can help you stay well. Prompt medical care may delay the onset of AIDS and prevent some life-threatening conditions. There are now medications to treat HIV infection and help you maintain your health. It is never too early to start thinking about treatment possibilities.

Take a TB (tuberculosis) test. You may be infected and not know it. Undetected TB can cause serious illness, but it can be successfully treated if caught early.
Smoking cigarettes, drinking too much alcohol, or using drugs can weaken your immune system. There are programmes available that can help you reduce or stop using these substances.

You also have the responsibility to ensure that you do not transmit infection to others. Abstaining (not having) from sex is the most effective way to avoid transmitting HIV to others. If you choose to have sex, use a condom to help protect yourself from other infections and your partner from HIV.

Q70. Are blood and blood products in India safe?

Every bottle of blood donated should be tested for antibodies to HIV. Further, it must be recalled that if a person in the early stages of HIV infection donates blood, antibodies will not be found while screening it. If this seemingly safe blood is used for transfusion, the recipient is at high risk of contracting the virus. As for blood products such as manufactured or imported into India, all are certified free of HIV antibodies. It is advisable to use blood and blood products from Government certified blood banks.

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Prevention

Q71 Why do young people need to know about HIV infection and AIDS?

Unlike many diseases, HIV infection and AIDS are preventable. While it can be disturbing to think about HIV and assess your risk, getting up-to-date information is the first step toward protecting yourself.

Q72. Globally, what do we know about young people's knowledge levels on HIV/AIDS?

Studies from across the globe have established that the vast majority of young people have heard of AIDS, but have no idea how HIV/AIDS is transmitted or how to prevent infection. Surveys from 40 countries indicate that more than half of young people have serious misconceptions about HIV/AIDS - that a healthy-looking person cannot have HIV, or that mosquitoes can transmit the virus.
A large percentage of young women aged between 15 to 24 years do not have sufficient knowledge about HIV and knowledge is the only way to protect one self.

Q73. How can one avoid getting HIV/AIDS through the sexual route?

A person can avoid HIV infection through sexual route by

Abstaining from sex.
Having a mutually monogamous sexual relationship with a person known to be HIV- negative.
If not certain of the HIV status, use a safe method such as condom.

Q74. Is abstinence the only solution in the prevention of HIV?

Abstinence means refraining from sexual activity or certain sexual behaviours. This can certainly eliminate risk of HIV. This is one of the important ways of prevention of HIV transmission through sexual route. But don't forget the other modes of transmission too. You need to be informed about them and follow safe behaviours, in relation to such modes of transmission.

Q75. What is Safe Sex?

Safe sex involves finding ways to be intimate while minimizing the risk of HIV transmission. The most important safe sex method and the only absolutely safe one is abstinence from any behaviour that exposes oneself to another person's bodily fluids. Use of condoms during sexual activity is a way to protect oneself against HIV infection. Practicing safe sex may also protect you against other sexually transmitted infections.

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Condoms for Prevention

Q76. What is a condom?

A condom is a sheath of thin latex rubber, which is unrolled onto the erect penis and worn during sex. At the tip of most condoms there is little extra space to hold any semen that gets ejaculated. The condom keeps the semen from coming into contact with the other person's body fluids, especially any open cut that could allow blood to mix with the semen.

Q77. Does the use of condoms ensure 100 percent protection from HIV infections?

Condoms, when used consistently and correctly, are highly effective in preventing sexual transmission of HIV. It should be noted that condom use cannot provide absolute protection against HIV. The surest way to avoid transmission of HIV is to abstain from unprotected sexual intercourse or to be in a long-term mutually monogamous relationship with a partner who one knows is uninfected.

Q78. How can one get condoms?

They are available free at all primary health care centres, sub centres and with all paramedical persons. They are available at chemists shops, groceries and pan shops. There are different brands, colours, flavours and varieties of condoms.

Q79. Are some condoms better than others?

Yes, only those condoms manufactured to international standards by good companies are reliable. In India, condoms can be purchased from many outlets including pharmacies, supermarkets and in villages at the pan shop. Try to buy condoms from a cool place because high temperatures and humidity can hasten deterioration of latex. Also, the government gives free condoms. These are available at health centres. Always check the "sell by" or expiry date.

Q80. How does one get one's partner to use a condom?

Sometimes people are reluctant to use condoms, because they think that condoms diminish the experience of sexual intercourse. It is easier to promote condom use between two partners when they talk about using them before engaging in sexual intercourse. Talking about preventing an unintended pregnancy or STI before sexual intercourse may help partners understand the importance of using condoms.

Q81. Do condoms reduce sexual pleasure?

It is true that in the old days, the condoms were stiff and thick and uncomfortable for many men. However, condoms are now so thin, elastic, only 0.06 mm thick and strong that very little sensation, if any, is lost.

Q82. Are there any condoms for females?

Yes. These are called female condoms. The female condom is a polyurethane sheath or pouch about 17 cm (6.5 inches) in length. A woman wears it during sex. It entirely lines the vagina and it helps to prevent pregnancy and sexually transmitted infections including HIV. But these are not commonly available in our country.

Q83. How many times can a condom be used?

Condoms can be used only ONCE, they should not be reused. After one use the condom looses its lubrication and elasticity and if reused it will not play its role of a protective barrier. Also, it may tear on reuse. It is believed that limited availability and high cost have led some women to reuse female condoms in some countries. It is recommended to use a new male or female condom for every act of intercourse.

Q84. What precautions should be taken if a condom is torn during sexual intercourse with sex partner?

If a condom tears during sexual intercourse, then pull out quickly and replace the condom. While having sex, it is better to check the condom some time, to make sure it hasn't split or slipped off. If the condom has torn and it feels that semen has come out of the condom during sex, one should consider getting emergency contraception with due consultation of a physician or a gynaecologist. However, even though you may prevent unintended pregnancy, you may possibly get infections like STIs/HIV if your partner has any of these infections. You must visit a VCTC and should find out what to do if you suspect/know that your partner may have an STI/HIV.

Q85. Can we prevent HIV by using more than one condom at a time?

No. Wearing more than one condom at the same time will cause friction, which may result in tearing of the condom. Correct use of one condom during a sexual activity should protect you from HIV.

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HIV Symptoms

Q86. What are the external signs and symptoms of HIV infection?

Immediately after infection, some people may develop mild, temporary flu-like symptoms or persistent swollen glands. The other symptoms that may develop are:

Weight loss >10% of body weight.
Fever for more than one month, intermittent or continuous.
Chronic diarrhoea for more than one month

Q87. Do HIV infected people look different?

One cannot tell by looking at someone whether he or she is infected with HIV or has AIDS. An infected person can appear completely healthy. It is only through blood test that the HIV status is confirmed.

Q88. Where is HIV found in the body?

HIV is found in blood, and in the body inside the CD4 cells, central lymphoid follicles, brain, genitals, liver, spleen, kidneys, bone marrow, cerebrospinal fluid, breast milk etc.

Q89. In which part does HIV enter first?

Whatever may be the entry point HIV usually reaches the nearest lymph node.

If it enters through unprotected sexual intercourse then it goes to the nearest lymph nodes.
If it enters through a contaminated needle it reaches the nearest lymph node and it may enter the blood stream directly.
If it enters through a vein then it goes directly into the blood stream.
If it enters from an infected pregnant woman into her new born baby it goes all over the baby's body.

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HIV and Young Women

Q90. If a woman is married and faithful to her husband can HIV affect her?

Yes, HIV can affect her if her husband has unprotected sexual intercourse outside the marriage or is injecting drugs and then has unprotected sexual intercourse with her.

Q91. Should you tell your partner about the test result?

Even though telling your partner about a positive test result could cause enormous shock, anger and may be the end of your relationship, it is very important to let him or her know. Why? Firstly, if you are into a sexual relationship he/she needs to get tested. If she too is positive like you, you can both minimize the chance of the infection. Secondly, if she is not infected she has a right to protect herself. It is better to hear it from you than as rumor from somebody else. Thirdly, it provides time and opportunity to change lifestyles and seek medication to prevent the onset of serious infections. If summoning the courage to tell your partner is difficult, seek help and advice from counselors and support groups. You should be able to get their names from your hospital or local NGOs.

Q92. Why is testing recommended for pregnant women?

There are now medical therapies available to lower the chance of an HIV-infected pregnant woman passing HIV to her infant before, during, or after birth. ZDV (zidovudine, also known as AZT or ART) is the only drug which has been proven to reduce perinatal transmission. HIV testing and counseling provides an opportunity for infected women to find out if they are infected and to gain access to medical treatment that may help to delay disease progression. For women who are not infected, HIV counselling provides an opportunity to learn important prevention information to reduce the possibility of future exposures.

Q93. Is there anything I can do after unprotected sex to avoid pregnancy?

Emergency Contraceptive pills reduce the risk of pregnancy if taken within 72 hours of unprotected vaginal intercourse. The sooner they're taken, the better. They work best when taken within 72 hours. During this time they can reduce the risk of pregnancy by 75 to 89 percent. There are several dedicated products available in the market. IUD insertion by a skilled health provider, can be effective within seven days of unprotected intercourse. This is usually not advised for unmarried young girls/women.But remember, an unprotected sexual contact may also be a source of HIV transmission, which cannot be prevented by emergency contraception.

Q94. If a woman is pregnant and HIV positive, will her baby be HIV positive too?

Most babies born to HIV-infected women escape the virus, but 1 in 4 does become infected before or during birth or through breast-feeding, although no one is certain when viral transmission occurs. Transmission may also be linked to the mother's health during the pregnancy or birth. There are more viruses during the earlier stages of HIV/AIDS than later. Currently, physicians may prescribe Anti Retroviral Drug (ARV) for infected pregnant women to reduce rates of transmission; effectiveness of this therapy increases, the earlier HIV is diagnosed during the course of infection.

Q95. Are homosexual women (lesbians) at risk of HIV?

The risks of sexually transmitting HIV between women are very low. Very few women are known to have passed HIV on to other women sexually. Oral sex is low risk- but there is increased risk if woman has cuts or sores on her mouth, or her partner receiving oral sex has sores on her genitals or is having her periods.

Q96. Is it true that infections in women are often caused by the high-risk behaviour of their male partners? If yes, what should women do?

It is critical for women to be equipped with more information about their risk and have greater access to healthcare services. Currently girls and women have little control over their sexual lives, making prevention enormously difficult. While it may be possible to change some of the gender-related social norms that make women vulnerable, such efforts are difficult and may take years. The development of new prevention technologies such as vaccines and microbicides shows promise. Since it is unclear when these new technologies will be available and how effective they will be, it is important to continue with other forms of risk reduction.

Q97. What female-initiated preventive technologies already exist?

The female condom stands as the first and only female-controlled barrier to infection. Unfortunately, many women in developing countries including India do not have access to the female condom. It is not as readily available as the male condom, and is expensive. In addition, the female condom is not ideal for some women because it may involve negotiation with a male partner.

Q98. Is HIV infection different in women and men?

The difference between men and women is that HIV-infected women often have additional problems such as repeated vaginal yeast infections, especially as the immune system becomes weaker. More serious infections, such as PID (pelvic inflammatory disease-an infection of a woman's internal reproductive organs), can be harder to treat because the body can't help in fighting off infections as well. Diseases of the cervix, such as pre-cancer (dysplasia) and cancer, progress faster. They can be harder to treat if a woman has HIV.

Q99. What can be done to stop men's violence against women?

Men are as caught up in traditional gender roles just as women are. Many violent men come from families with violent fathers. This is not to excuse their violence, which of course is wrong, but they need help to understand why they turn to violence when they feel upset. It is often to do with patterns they have learnt in childhood-they have never learnt to deal with their frustrations in other ways. There are various initiatives now in different parts of the countries where men have learnt to unlearn violence- and have seen that they can still be real men. They have learnt that their own lives have improved, as well as the lives of their friends and families around them.

Q100. What is meant by "gender and HIV" ?

You must have heard the word Sex. This determines biologically whether one is a boy or a girl. Gender on the other hand is a social construct that defines how a girl and boy should behave. In countries where young people account for a high proportion of all new infections, HIV positive young women may outnumber their seropositive male peers by as much as six times (UNAIDS). Therefore, addressing gender roles and power dynamics between women and men, and how they impact on sexual relations and decisionmaking, is critical for effective prevention.Girls and women are disproportionately vulnerable to HIV. Their physiological susceptibility, at least 2 to 4 times greater than men's - is further increased by social, cultural, economic and legal forms of discrimination. HIV prevention programmes cannot be successful unless we foster gender equality; empower girls and women and enable boys and men to become supportive, responsible partners.

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Responses to HIV/AIDS

Q101. How should the government share responsibility?

The Government is responsible for ensuring that adequate resources are allocated to HIV/AIDS prevention and care programmes. All individuals and groups in society have access to these programmes, and the laws, policies and practices do not discriminate against people living with HIV/AIDS. It is also being ensured by the Government.

Q102. What role do NGOs play in AIDS control?

NGOs have an important and very special role to play. The close interpersonal interaction that NGOs have with people in the communities is extremely useful for implementing programmes more easily. They can supplement the government's work.

Q103. How much money do we need to eradicate HIV from the world?

At the UN General Assembly Special Session on HIV/AIDS (UNGASS) in New York in 2001, 189 countries took on a commitment strongly to increase resource for the fight against HIV/AIDS. Kofi Annan, Secretary General of the United Nations, asked the governments to donate at least USD 10 billion per year to the struggle. The World Health Organisation (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have estimated that, from 2007 and for ten years onwards, the world will need to allocate US dollar 15 billion per year to manage the pandemic.

Q104. Is HIV/AIDS just a health issue?

HIV/AIDS is not simply about health though it is still seen only as being about health. Fundamental issues of empowerment, equality and rights are very important for prevention of HIV/AIDS. HIV/AIDS requires a response.

Q105. What about insurance of people living with HIV?

It is very likely that anybody seeking life or medical insurance will have to prove that he is not an HIV carrier. For those infected several years after their insurance coverage began, it is unlikely that the insurer can refuse to pay claims. But the insurer could try to argue a "pre-existing condition" and refuse to honour claims. A pre-existing condition is any condition the insured knew he or she had or should have reasonably known at the time of taking out the policy. Clearly, the relationship between insurance and HIV is complex.Notwithstanding these complexities, Employee State Insurance Scheme, the largest health insurer for employees of state government institutions, covers expenses for HIV and related opportunistic infections treatment at subsidised rates. Similarly, Central Government Health Scheme, for employees of the Central Government, also supports medical expenses for Anti-Retroviral therapy. Insurance cover for HIV by private insurers and state supported insurance agencies like General Insurance Corporation, National Insurance Scheme etc are still under debate.

Q106. What are the channels of communication that can be used for HIV/AIDS awareness?

To reach all the individuals in your community personally will be an impossible task. Therefore, you will need different strategies to reach different groups of people to raise awareness in the general population. Information, education and communication (IEC) campaigns can be used. This includes the design of informational posters and pamphlets and their distribution in clinics and other public places. In addition to written material, information must also be provided for those who cannot read. These IEC activities include radio talks and the use of performing arts, such as story-telling and drama shows.

Q107. What does one do if they know a person is living with HIV?

Respect the person's privacy and do not spread the word about his or her infection. One should maintain confidentiality about the HIV status of an individual because they have the right to live in dignity. Also if confidentiality is not maintained then no one will come forward for HIV testing and it will become very difficult to control the infection spread.

Q108. Do people living with HIV/AIDS have special rights ?

Since everyone is entitled to fundamental human rights that prevent any sort of discrimination against them, people living with HIV/AIDS have the same rights like non-infected people. HIV infected people also have the right to education, employment, health, travel, marriage, privacy, social security, scientific benefits, etc.

Q109. Who should provide care to HIV/AIDS infected persons?

When a person has got infected with HIV, everyone associated with him or her should provide support. In particular, this includes healthcare workers at various levels of the healthcare delivery system, social workers and counselors, and close family members who are important care providers at home. Care basically involves clinical management, nursing care, counseling and social support. Care doesn't mean technical or medical care only; it includes the mental support that creates a feeling of normalcy in the mind of the infected person. We all should be compassionate to infected persons.

Q110. If an individual is HIV positive, should he or she be allowed to continue work?

Workers with HIV infection who are still healthy should be treated in the same way as any other worker. Infection with HIV can never be a reason in itself for termination of employment. If anyone is losing their job because of his or her positive status, it is certainly a violation of rights.

Q111. What is the advantage of involving youth in HIV programmes?

When young people are involved in programme design at the formation stage, they generally feel more strongly that the project belongs to them. This enables them to develop a stake in it and be committed to its outcome. Youth input can help ensure that programmes that are designed are relevant to their needs. Young people can help identify messages, communication channels and activities that are popular in their culture and community. It is important for a message or information to be expressed in a language that young people understand if it is to effectively reach the youth audience. Involving young people in programme design can effectively publicise such programmes. The young people themselves are able to reach out to their peers.

Q 112. How can I support HIV Positive Young Persons in my community who are having some problems?

Remember CLUES - Five Action Steps to Help a Person in Problem

C   Connect. Make contact. Reach out, talk to them. Notice their pain.
L    Listen. Take the time and really pay attention. You don't have to have all the answers. Just listen.
U    Understand. Nod, pay attention, let them know you appreciate what they are going through.
E    Express Concern. Say that you care, you are worried, and you want to be helpful.
S    Seek Help. Tell them you want to go with them to talk to a third person, preferably an adult with experience and the ability to help. Help them enlarge the circle of support.

Q113. What can I do for a friend or family member with HIV?

People with HIV need support and friendship. They may feel alone, frightened and unsure of their present and future. Fortunately, there are organizations which help people with HIV and their families deal with the medical, financial and emotional problems associated with the disease. Yet, you can be a good friend of people with HIV/AIDS and show that you care about them.

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