MODULE 4

The fourth module deals with measures to be taken in order to prevent HIV AIDS.

1)    The most effective way to prevent contraction of HIV through sexual contact is to follow single partner policy. Those who have multiple sexual partners can protect themselves from HIV by following safe sex practices and condoms. Condoms are not 100% safe as there are always chances of condoms tearing or leakage due to improper use. The chances of getting infection from an HIV positive individual, who is under regular treatment and with low viral load, are negligibly low. It is because body fluids of such individuals, who are on treatment, will have very low HIV viral content. For the same reason, treatment of HIV infected individual is also an effective method of prevention of transmission.

2)    To prevent HIV transmission through blood transfusion, samples from donated blood are subjected to HIV tests. ELISA test is commonly used for HIV screening of donated blood. If the blood donor is in the window period of HIV (10 days to 3 months), their ELISA might give a negative result. To overcome those technical drawbacks, blood donors are interviewed prior to donation and are asked for history of any high risk behaviour in the prior 3 to 4 months. In spite of this, rarely we have read in news about people getting HIV through blood transfusions during the window period. To avoid this there are directions to encourage only voluntary blood donations and not mandatory donation by patients’ relatives or friends. The latest advancement in HIV testing called NAAT or nucleic Acid Amplification Test can shorten window period to less than a week. This can further reduce transmission of HIV during window period. States like Karnataka have introduced the technology to their blood banking system. Some private blood banks and hospitals also have this facility.

3)    There are effective medicines to prevent transmission of HIV from mother to child during pregnancy and child birth. All pregnant ladies should undergo HIV tests. Those who are HIV positive will have a significantly low HIV viral load once their antiretroviral treatment is started. Thus chances of transmission of HIV from mother to child during pregnancy and child birth can be reduced. Caesarean sections have lower chance of HIV transmission than normal delivery. The infant is given drugs within 2 hours of birth to prevent HIV infection. This prophylaxis will continue for a few more weeks and the drugs used are Nevirapine or Zidovudine. Ideally the baby should receive exclusive formula feeds and not breast milk. But in developing and under developed countries, guidelines recommend exclusive breast feeding to infants. Socially and economically backward parents will find it extremely difficult to give formula feeds in adequate amounts in a hygienic manner. There have been several reports of infant deaths either due to malnutrition resulting from inadequate amount of formula feeds or due to severe diarrhoeal diseases resulting from unhygienic feeding practises. If the mother takes appropriate treatment throughout, HIV load in her breast milk will be too low to cause transmission to the infant. Mandatory HIV screening of pregnant ladies and prompt initiation of treatment, if found positive have resulted in almost zero case of newborns with HIV in the state of Kerala. But in rural India, there are many women who never visit hospitals for delivery or for pregnancy checkups. Infants of such mother,s still get HIV infection and this happens even now in other states.

4)    Sharing of common needles, results in HIV transmission and hence destruction of needles after use is encouraged. Nowadays, in healthcare settings, re-use of needles or syringes is not practised. All needles and syringes are destroyed or safely disposed after use. But those individuals who use drugs might share a single needle resulting in HIV transmission. To prevent this, govt had initiated a safe needle programme which supplied single use clean needles to drug abusers. Health care workers can also get injured from surgical blades or needles used in HIV infected individuals. A splash of blood directly into eyes or mouth can also transmit infection. In such cases, post exposure prophylaxis drugs are available. These drugs which are to be taken daily for 4 weeks offer good protection. Drugs belonging to NRTI and Protease Inhibitor groups are used for prophylaxis. Ideally, post exposure prophylaxis should be started within 2 hours of exposure and it is not advised after 72 hours. Many who take prophylaxis complain about vomiting and severe tiredness during the course. Post exposure prophylaxis can also be used in those individuals who are at risk of contracting HIV through other modes of transmission.

Thus HIV infection can effectively be prevented if proper preventive measures are taken. The next module deals with services provided by the government for HIV care and the scope of HIV care in the future.