In the table, against each type of exposure efficiency per single exposure and percentage of total number of HIV infected persons are shown. ‘Blood Transfusion’ has the highest efficiency, but the percentages of persons who get the HIV infection through this route, is very low i.e.3%-5%. As against this ‘sexual intercourse’ has an extremely low efficiency rate i.e.0.1%-1.0%, but the percentage of persons who get the HIV infection through this route is very high, i.e. 80%-90%. For instance, in India as of 30 November 1994, 905 AIDS cases were reported. Out of this total many as 676 persons got it through sexual route.

How is HIV not transmitted

We know that HIV is not passed on in these way as:

· Shaking hands

· Kissing and hugging

· Sharing cups, plates and other eating utensils

· Sharing toilet and bathroom facilities

· Through coughing or sneezing or through the air we breathe

· Sitting in the same class or canteen

· Sharing work instruments or machinery

· Swimming together or playing together

· Donating blood to the Blood Bank (with sterilized needles)

· Bites by insects, e.g. mosquitoes, bed bugs, etc.

One cannot get HIV/AIDS through every day social contact with a person infected with HIV.

Sexuality Transmitted Diseases

Why do we need to know about sexually transmitted diseases?

AIDS is only one of the sexually transmitted diseases (STDs) and knowledge about the others will help you to answer adolescents question. If the adolescents are already sexually active, it will help them to protect themselves from infection. If they are not sexually active, the information will provide a good basis for their understanding of AIDS.

What are sexually transmitted diseases?

STDs are those diseases which are transferred via mucous membranes and sections of the sexual organs, throat and rectum. Most STDs are easy to treat. It they are detected and treated early, they do not cause any serious problems. If they are not detected and treated early, they do not detected and treated early, the infection may spread and cause complications such as sterility. They are relatively easy to contract, and so it is important to know what they are, what they look like and what you need to do to get them treated.

In India, there is a very high incidents of STDs, primarily because contrary to popular belief many people in the country have sex with multiple partners. In addition to this there is lack of knowledge of STDs, inadequate health facilities, inadequate utilization of health facilities, due to stigma associated with STDs and urbanization which at times, compels the person to leave his/her spouse and family in villages. Limited condom use and lack of personal hygiene are other factors.

HIV infection/AIDS is also a kind of sexually transmitted disease, the significant difference being that while most of the other STDs can be cured, HIV/AIDS is incurable. The incidence of HIV/AIDS is found to be directly co-related to the incidence of other sexually transmitted diseases, so people at low risk of STDS are also at low risk of HIV. For this reason too, it is important to concentrate on the prevention and treatment of STDs. The life style which prevents STDs will also prevent HIV.

Prevention of STDs infection: Abstinence from all sexual activity is the most effective prevention. However, most people do not choose a lifetime abstinence. The risk of acquiring an STD, including HIV is virtually absent when one has sexual intercourse with a mutually faithful monogamous uninfected partner. In all other situations condoms should be used for protection against infections. Personal hygiene (washing of genitals after intercourse) might also contribute to prevention of infection, but by itself this is less effective than condom use.

Signs and Symptoms of STDs : All STDs will not have signs and symptoms and the same STD may seem different in different people. It is extremely important to note that many women and some men have an STD without sign or symptom. The following signs could indicate presence of STD in a sexually active person:

Women : An unusual discharge or smell from vagina. Pain in the pelvic area between the navel and sex organs. Burning or itching around the vagina. Bleeding from the vagina which is not the menstrual flow. Pain inside the vagina when having sex. Swelling in the groin- area around the sex organ.

Men : A drip or discharge from penis:

A person may be infected for some time and not know it. The danger is that the person can spread the disease to others without realising it. It is important that sexually transmitted diseases are adequately treated. If not, they can become chronic and be the case of serious complications. For adequate and effective treatment it is necessary to go to a qualified doctor. Self treatment or treatment by quacks is not advisable. One should not fell ashamed to go to a doctor. It is the doctor’s duty to maintain strict confidentiality.

HIV/AIDS : Its Prevention and Control

How to prevent and control HIV/AIDS is a very difficult question. There is no preventive vaccine or cure. The only option available is to prevent it by observing practices that are safecompliance with such practices can make a significant difference. The discussion in the following pages, therefore, is focussed on the preventive practices regarding three major routes of HIV infection: Sexual Intercourse; Blood; and Mother to Child.

Sexual Intercourse:

In the most cases, HIV infection is caused by unsafe sex practices. A healthy attitude towards sex and observing responsible sexual behaviour can produce the changes of getting HIV infection. Abstinence from sex, sticking to one uninfected life partner and not having multiple relations (or not having pre-material and extra-material sexual relations) constitute responsible sexual behaviour which are the best guarantees against HIV/AIDS.

Use of condoms : Sex plays a very important role in a person’s growth in to adulthood and in his/her subsequent life. Decisions regarding sex must be based on careful and mature consideration: References to sexual behaviour have been made only in the context of HIV/AIDS. The use of condoms is recommended not only for avoiding unwanted pregnancy but also as a ‘protection’ against HIV/AIDS and other STDs. Although the use of condom provides good protection, it should be remembered that it does not make sex 100 percent safe.

   Blood:

Another Route of HIV Infection is through blood.

Sterilized syringes and needles : Great care should be taken that instruments which draw blood and are used in activities such as circumcision, tattooing or ear piercing, are sterilized after use if they are to be used again. Instruments can be cleaned by leaving them in a solution of one part bleach* (powder or liquid) to nine parts water (1:9) for 30 minutes or boiling them in them water for 20 minutes. Do not get ‘injections’ from unqualified doctors. The needles and syringes used by such practitioners are not sterile. If injection is needed, one must ensure that the syringe and needle are disposable or properly sterilized. There should never be any sharing of needles and syringes while taking an injection.

Blood Safety : The Blood Safety programme is an integral part of the AIDS Control programme. In India there are more than 1000 blood banks, both government and non government, which collect and supply blood. HIV Zonal blood testing centres have been set up in many cities and towns of the country. The centres receive samples of blood from blood banks for HIV testing. Under the drug and cosmetics Act, it is mandatory to test every unit of blood for HIV. The Zonal blood testing centres and district level blood banks have been provided with testing kits and the necessary equipment for conducting tests. The blood of a donor is discarded if it is tested HIV positive. In order to know the prevalence and progression of HIV in the community and the country as a whole, the mechanism of sentinel surveillance has been established. This is being done through screening of the blood samples, collected from sentinel sites including STD clinics, antenatal clinics, drug de-addition clinics, etc, the surveillance date from different states is complied at the national level. Efforts are also being made to augment voluntary blood donations and to phase out professional donors.

Mother to Child :

The risk of an HIV infected mother passing the virus to her unborn child is about 30% the risk being greater if she has symptoms of AIDS rather than if she has no symptoms. The risk of passing HIV through breast-milk is relatively small. Breast-milk has many substances in it that protect an infant’s health and the benefits of breast-feeding for mother and child are well recognized. Bottle feeding is not safe because of difficulties in sterilizing the feeding bottles or lack of clean water supplies. In developing countries, the risk of an infant becoming infected through breast-feeding is usually outweighed by the benefits of breast-feeding. A woman who is infected with HIV may wish to consider carefully the pros and cons of pregnancy in the light of 30% chance of child getting AIDS. She may also consider the factor that the surviving children would ultimately become orphans as their parents would die of AIDS.

"No Risk" or Safe Behaviours

The following "no risk" behaviours" are extremely important:

1. Responsible Sexual Behaviour :

a) Abstinence from sexual intercourse before marriage is a "no risk" behaviour. In this context, the traditional value of ‘no sex’ before marriage is important to stress. Students may be encouraged to discuss the significance of this traditional value in the contemporary situation. Abstinence is a responsible behaviour and students need to discuss the reasons or observing abstinence and learn how to resist pressures to have sex.

b) Sex with one uninfected faithful partner is another "no risk" behaviour. In this context, it is important note that this is in consonance with the Indian value which discourages pre-marital and extra-marital sex.

c) Use of condoms

2. Not sharing needles/syringes and using sterilized/disposable needles and syringes for all purposes.

3. Ensuring that one accepts HIV free syringes/blood transfusion, if and when necessary.

" Risky Behaviours"

The following behaviours carry the risk of HIV infection/AIDS:

1. Not sticking to one uninfected partner or having multiple sex partners.

2. Having sex with a person who has multiple sex partners.

3. Sharing unsterilized needles and syringes, accepting untested blood transfusion.

Women and Aids

AIDS was first discovered among homosexual men in United States. Till some years later it was considered to be a disease that affected only men. Now, in the 1990’s it is becoming increasing clear that AIDS is disease which will have a major impact on women and children. In Africa, half of all HIV infections are among women and children, infant mortality rates are increasing rapidly due to number of children born with AIDS. AIDS will single handidly wipe out all the advances made to date on maternal and child health, and by the year 2000, WHO estimates that there will be 10 million uninfected orphans whose parents have died of AIDS.

Risks for Women

Biologically more vulnerable : Women are biologically at a greater risk than men - it now appears that male to female transmission is 2-4 times as efficient as female to male transmission, while, with other STDs male to female transmission is at least 15% more efficient than female to male transmission.

STDs not diagnosed or treated : Many women suffer from asymptomatic STDs or have symptomatic STDs which are not diagnosed or treated, In addition, women have a limited access to STDs treatment facilities and health care in general. Should a woman go to an STDs clinic, she is often considered a sex worker.

Use of non-barrier methods of contraception : Women use contraceptives without accurate knowledge of its relationship to HIV infection. Use of IUDs could put a woman at greater risk, while use of other contraceptives such as the pills, injectables and implants discourages the use of condom.

Receive unnecessary blood transfusion : Women often receive blood transfusion related to child birth or anaemia, often unnecessarily.

Traditional practices : Traditional practices such as female circumcision, tattooing, etc. could place women at risk.

Others risks for women : Women are at risk for HIV infection and other STDs just like men if they have multiple partners, and inject drug. But women are also at a risk of contracting the HIV infection from coercive sex, due to their economic status which force many women into selling sex for money. In addition, Many women are at risk of HIV infection from their partners. One estimate claims that, every day 1500 women become infected with HIV and their only risk behaviour is having sex with their husbands.

The Asia including India has a long history of traditional use of locally produced drugs, such as cannabis and opium. In recent years the region has become a transit point for the international drug trafficking. Drug abuse is on the increase, and so are the problem caused by this abuse. It causes not only the deterioration in the family life and violence. In more recent years the lifestyle and risky behaviour of drug users are also linked to the HIV/AIDS pandemic.

In India the abuse of heroin was confined to smoking and inhaling until about 1993. At that time the practice of injecting heroin began to increase. Today, it is a major concern in several parts of the country, especially Urban centres like Mumbai and Delhi and the North- Eastern states bordering Myanmar which together with Loas and Thailand constitute the Golden Triangle. Among the North-eastern States a significant increase of HIV infection was initially noticed in Manipur in 1990. It has now expanded to Nagaland and Mizoram as well. The HIV prevalence among injecting drug users in Manipur is among 60-70 per cent. It has reached 50 per cent in Nagaland and 6-10 per cent in Mizoram. Among the likely sources of infection in the reported AIDS cases in India injecting drug use accounts for 5.3 per cent. What is more disturbing is that the rapidly growing HIV infection among the likely sources of infection in the reported AIDS causes in India injecting drug use accounts for 5.3 per cent. What is more disturbing is that the rapidly growing HIV infection among injecting drugs users in Manipur is followed by a slower but steady increase of prevalence in the general female population.

The worst aspect of the drug abuse is its deepest impression on the school and college going youth who is most vulnerable. Most drug users begin taking drugs at an early age, as adolescents or even younger. Young students take to drugs due to peer pressure, curiosity, ignorance, changing social structure, urbanization and other related causes.

Teachers Role as AIDS Educators

While traditionally psychologists, social workers and doctors have served as counsellors, it is important to explore the role of teachers as AIDS educators with young students. What a teacher needs to do is to gain the trust and confidence of students.

Responsible sexual behaviour being an important component of AIDS education, a teacher has to function as a resource for accurate information in matters relating to sex and sexuality which are sensitive in nature. Many teachers find it difficult to get over their embarrassment and shyness while dealing with such issues. With training, the embarrassment and shyness can be overcome among the teachers and they can be in a better position to communicate with the students in their own language and appreciate their problems and needs. The advice given by the teacher is more acceptable to students with a higher possibility of behaviour change.

It is extremely important for teachers to be non-judgemental so that he/she can treat the student as a person needing understanding, compassion and care. In communicating about AIDS/STD, understanding, compassion and care are very important for bringing about desirable change.

The teacher should not put off a student when he/she asks questions. Teacher should not tell the students that their questions are silly but rather tell them that their questions are very genuine and relevant.

The teacher may try to answer a student’s questions as best as he/she can. For personal problems too the teacher may advise the student to the best of his/her ability. At the same time, if the problems demands, the student should be advised to consult a qualified doctor/counsellor for further treatment/counselling. The student should also be advised to talk to his/her parents in case of any serious personal problems.

The teacher should ensure that his/her students understand the following crucial messages:

i) Since there is no cure for HIV/AIDS prevention is the only defence at the movement.

ii) HIV can be transmitted through unprotected sexual intercourse, unsterilized needles and syringes, and contaminated blood.

iii) HIV transmission can be prevented through abstinence and mutually monogamous sexual relations in which neither partner is HIV infected. These constitute responsible sexual behaviour.

iv) Use of condoms minimizes the risk of HIV transmission as it reduces exposure to blood, semen or vaginal fluids.

v) The risk of exposure to HIV increases with increase in sexual partners.

vi) Drug injectors must not share with anyone else syringes or other drug-related instruments that pierce the skin.

vii) In case of blood transfusion it should be assured that the blood is tested for HIV.