Tuesday, November 30, 2010

AIDS: Striking on Backbone of Nation

Youth is the backbone of any nation. The development of a nation is directly dependent on the health of its youth population. Youth of any nation is that population which belongs to the age group of 20 to 40 yrs. This work force is directly involve in the activities of economic development , financial development , technological development and other development which makes a country feel proud on this community. Imagine, if this segment is got paralyzed then what happens to the growth of that country? AIDS is such kind of threat to this segment which is trying to paralyze not only the youth of India but also the world. In context of India about 35 to 40% population is belongs to the age group of 20 to 40 yrs. India is fast growing economy and this fast growth is only achieved by this youth community. But in now days AIDS is directly attacking on this community because of their high level of sexual behavior and due to lack of awareness, the mouth of this threat is expanding. This is time where we (the youth community) should raise our hand against AIDS and completely root out AIDS from India, in fact world. Spread the awareness about AIDS and share it to as many as possible because this is the only measure of treatment of AIDS. No other measure till the date found to fight against AIDS and save the youth community. Awareness is the only weapon which can be used to fight against this epidemic. According to global summary 1991, by means of exposure the chance  of transmit of AIDS is 90% through blood transmission 30%  from parents to its unborn baby, followed by injecting drug use , sexual intercourse and healthcare which are (0.5-10)% , (0.1-1.0)% and less than 0.5% respectively. A below fig. show the summary

Whereas the globally sexual intercourse are the main mode of transmission which account for (70-80) % followed by other modes of transmission as shown in picture below. 
According to NACO’s August 2010 data, 357808 AIDS patients in ART centers in different states admitted among which 336465 are adult and 21343 are pediatric. Below fig. shows the state wise analysis of the AIDS patients. Highest no. of AIDS patients belongs to Maharashtra followed by Andhra Pradesh, Karnataka, Tamil Nadu, Gujarat, Utter Pradesh, Rajasthan, and Delhi. The lowest population in the ART centre are in North-Eastern states among which Arunachal Pradesh has the lowest one which is 26. These data are about the patients who registered with ART centers in the corresponding states. An estimated fig. of HIV/AIDS patients in India is 2.27 million. Third largest nation living with AIDS patients.
When a perato analysis has done it shows that only eight  states(Maharashtra, Andhra Pradesh, Karnataka, Tamil Nadu, Gujarat, Utter Pradesh, Rajasthan, and Delhi.) constitute 84.35% of total AIDS patients in the month as shown below.

Definitions

AIDS: Acquired Immune Deficiency Syndrome – is a condition in which the in- built defence system of the body break down completely. This phenomenon is gradual, but ultimately leads to total depletion of a very important cell component of the immune mechanism. Those affected are thus unable to combat commonly known diseases like pneumonias, diarrhoreas, tuberculosis (TB) and even common colds; ultimately they die due to one or another of these infections. Because of varied nature of these diseases, called ‘AIDS associated’, AIDS related’, or AIDS indicator diseases’ (including cancers), AIDS has been identified as a syndrome rather than a single clinical entity. This means that AIDS patients show several signs and symptoms which occur together at the same time. 
The centre for disease control and prevention (CDC) has added a new dimension to the definition of AIDS, viz. an accurate counting of a particular cell type CD4-T Cell. If these cells are less than 200/cu mm in blood of an individual, then he/she is considered to be a patient with AIDS.

Causative Agent of AIDS

A virus called “HIV” (Human Immunodeficiency Virus) is responsible for breaking the immune system of the human body or developing AIDS in the human body. A healthy person if infected with HIV by any means his inner body capacity to fight against the diseases start decreasing and later after about 9yrs, symptoms of multiple incurable diseases shown in the patient. At this stage the infected person no more to do rather to wait for his painful death. To discuss how this virus break the immune mechanism of human body first we understand the immunity of human body.

Immunity of Human Body
Immunity of the human body is that kind of defence mechanism which saves the human body by different kind of attack of harmful microbes (Bacteria, Virus, and Parasites etc.). This mechanism save the body from all this kind of microbes and leads a healthy life. But when some kind of microbes infiltrate into the body the mechanism catch it and kill them before they make any harm to the body.
Human body has three kinds of Immunity.

Innate / Genetic Immunity: First one is hereditary immunity which passed on from the parents to their newborn babies in the form of gene. This immunity is very fast and activate immediately whenever any harmful microbes attack on the body. This immunity has memory less characteristics as this do not memorize the identity of the microbes but only kill them.

Acquired Immunity: This immunity is developed by the human body itself by means of experience of diseases or exposure with the environment. This Immunity has memory based characteristics and always makes an image of the microbes in their database.

Induced Immunity: This type of Immunity is induced in the human body by means of some drugs for treatment of diseases.

Immune System of Human Body
First I would like to discuss the mechanism of the immune system of the human body. In next heading I will discuss how HIV infiltrate and break the immune system of human body which is very important to understand before discussing that how HIV spread? The blood of the human body is mainly two kinds of particles liquid and solid. Liquid parts consist of plasma, hemoglobin, protein etc. and the solid parts consists of RBC (Red Blood Cells), WBC (White Blood Cells) and the third one is Platelets. Red Blood Cells are responsible for distribution of oxygen and energy to all the parts of the body. Platelets responsible for clotting of blood inside and outside body whenever any injury taken place in body. In case of dengue fever the inside blood clotting stops due to decreasing of platelets in the blood and leads to the death of the patient. Remaining one is WBC which is mainly responsible for the immune system of the body. WBC comprises of two kinds of cells which have the prime responsibility of Defence mechanism, they are called Phagocyte (Second line of Defence) and Lymphocyte or Natural Killer cells (third line of Defence).
Function of Phagocytes (Second line of Defence):
These cells are called the second line of Defence of immune system of human body. Note that the first line of Defence of human body is the skin of the body which resists every harmful microbe to enter in the body unless it doesn’t get any kind of cut or scratch mark. Now whenever any kind of harmful microbe has entered into human body by mouth or other openings of the body the Phagocytes get activated immediately and engulf the microbes into it and kill the microbe immediately.

Function of Lymphocyte (Third line of defence):
If the size of microbe is larger than the phagocyte cell then the third line of Defence of human body get activated i.e. lymphocyte cells or natural killer cell are attacked on the microbes. These killer cell or cytotoxic cell or T- cell which got stuck with the microbe and secrete some toxic material and disintegrate the membrane of the microbe along with sending the image of the microbe to the B-cell, B-cell also get activated in case of failure of T-cell the corresponding B-cell (antibody) come and kill the microbe before it make any harm to the body.
In this way the immune system of the human body is always keep the safe and secure the body from the attack of outside harmful microbes.

How  HIV break the Immune system of The Human Body?

HIV when enter into the body by any means of transmission it enter into the body of B-Cell. This particular type of cell is named as CD4-T cell. It is not identify by the immune system that HIV has entered into the body of CD4-T cell because of high variation in image of HIV. This CD4-T cell becomes the host of this HIV for a long period of time and the HIV uses the protein or other material of this CD4-T cell for its incubation. HIV reproduced itself in the body of cell and rapture the membrane of the cell at later time and kill the CD4-T cell and large no. of HIV which have reproduced in the body of the CD4-T cell enter into the blood and start killing the CD4-T cell and a healthy person start complaining of different kind of diseases. Hence for confirm that a person is get infected HIV/AIDS the CD4-T cell is counted in the blood if the counting of CD4-T cell are less than 200/cu mm in an individual then he/ she considered to be the patient of AIDS.

AIDS in INDIA

What more worrisome is the fact that an overwhelming majority of AIDS patients have been between 20 to 40 years of age. They are the most productive group, economically and reproductively, a fact which imparts an extraordinary significance to AIDS. India is the second largest nation in the world on the bases of population and the 3rd largest nation living with HIV infected people (A provisional estimate of 2008-2009 is 2.27 million people) with estimated rate of prevalence is 0.29. Most frequent way of transmission of AIDS is heterosexual way of transmission. However in the northeastern region injecting drug use is the most frequent way. By NACO’s Annual report the estimated no. of people in India shows the decline trend as shown in the below picture.

Estimated adult prevalence of HIV in India also shows the decline trend.


"The decline of no. of AIDS patients and rate of Adult prevalence of HIV in India is because of NACO‘s nation wise awareness programme about AIDS after constitution of National AIDS Control Organization(NACO); at state level also in July 1992."

How HIV Spreads?  Or Modes of Transmission of HIV/AIDS

HIV/AIDS spread through following modes of transmission
  • By sexual Intercourse {Heterosexual(87.1%),Homosexual(1.5%)}
  • By injecting drug use (1.6%)
  • Blood and Blood Products (1%)
  • From parents to new infant (5.4%)
  • Some other source (3.3%)

Sexual Modes of transmission
Sexual intercourse the fastest way of transmission of HIV. This is because of natural body need of human kind. But Homosexuals also contribute in spreading of HIV along with heterosexual even with low percentage. 

A large source of transmission of HIV/AIDS is prostitution. According to the Annual report of NACO 2009-2010 about 12.7 lakhs commercial sex workers are active in India. Though they account for 0.5% population of total adult female population even they account for 7% for HIV infected females. Sex work is the most prominent way of transmission of HIV/AIDS because it has large client source in India. As per the national behaviourl surveillance survey 2006 mentioned in Annual report of NACO, about 2.4% adult males i.e. around 73.5 lakhs adult males have visited to commercial sex workers during the year prior to the survey. Men who buy the sex are the single most powerful driving force in India’s AIDS epidemics and constitute the largest infected population group in the country. These men transit the HIV to their wives or other male or female partners. The virus can be transmitted from men to men, men to women and to a slightly lower extent (two to five times less) from women to men. This is because of biological condition of women.

Infected blood or blood products
The second mode is through transfusion of HIV-infected blood or blood products or through infected blood in needles and syringes shared by intravenous drug users and those which might be reused by doctors/ nurses for injections without proper cleaning and sterilization. 

Infected mother to her newborn
The third way of transmission from an infected mother to her newborn.

Some other sources 
Some other sources are using the unsafe practices in barber shop such as using the same blade for multiple customers for saving and hair cutting without sterilized scissors. An important mode could be practices of  hair saving of children  at  holy places without  change of blade. The infected blade may cut the skin and HIV virus could easily pass from one child to another.

AIDS cannot be spread By

Just as important, or perhaps even more important, is to know how the virus does not spread among people. The fact that HIV cannot enter the body through most of our normal activities is emphasized. Among these are included hugging, kissing, eating, drinking, swimming, working and travelling together. One question often asked by people whether AIDS virus can be transmitted through bites of mosquitoes and other insects? Fortunately, experiments by artificially infected mosquitoes showed that unlike the malaria parasite or dengue virus, HIV has neither a life-cycle nor does it multiply in mosquitoes. The doubt that mosquitoes may take blood of an HIV-infected person and may act like a ‘flying needle’ has also been removed on epidemiological grounds. Studies in a large number of households of PWAs or HIV-infected persons in Africa revealed that transmission to an uninfected person occurred only through sexual partners. Children and other adults in the households remained free of HIV, despite having casual contacts with HIV/AIDS patients and despites the large number of mosquitoes in the environment.

Quality Control and interpretation of Serological Tests related to AIDS

In view of the medical and particularly social significance of a seropositive result, extreme caution is required in the performance of the various serological tests and their interpretations. The aim should be to obtain accurate, results so that a correct interpretation can be made. A ‘false positive’ result is potentially tragic and should be preventable before conveying to the concerned person. On the other hand, if ‘false negative’, the infected person may continue to infect others through high risk behavior. Quality control at every stage of testing should be introduced; similarly, proficiency of those carrying out the test should be checked periodically. 

Measure to Control the spread of HIV 

Safe sex practices :
Sexual mode is the most important, since it is the most frequent as compared to transfusion of infected blood or use of contaminated syringes and needles or reproduction (major presumption is that you and I are not IV drug users).

We know how the virus is acquired sexually, how it is helped further if we have other STDs. By now, we should know how to avoid it; the risk, of course, is not enjoying sex, it is in having it with an infected partner may pass on the virus, but the probability increases with increasing intercourse. By having multiple partners, i.e. being promiscuous, we face a high risk situation. But if some of us are unable to control this despite the risk, the only recourse is to use condoms any time, every time, anywhere and everywhere during sexual intercourse, unless, you have only one faithful uninfected partner, who in turn, is faithful to you.

Family welfare statistics of 2009 released by the ministry of health and family welfare this year puts Andhra at the bottom of condom use among married couples, with only 0.5% of the married couples using condoms for contraception. Karnataka comes next with 1.7% followed by Tamil Nadu with 2.3% condom users. Delhi tops the charts with a whopping 22.9% of couples using condoms –more than four times the national average of 5.2%. Punjab, Haryana and Utter Pradesh rank the highest with 15.5%, 11.8%, and 8.6% of couples using condoms. (Reference “Times of India”, New Delhi, Dated Nov.24th, 2010)

Use of alcohol and drugs which may lead to a rash, risky behavior should be avoided. The sure way of self-preservation to make the correct choice of a partner; if you still choose to promiscuous, be wise and use condoms; below fig shows some measures
Female condoms are being tried in some countries including Thailand now also available in India in some metro cities. But they are not freely available. Therefore, only men will have to remember or will have to be reminded that condom sense is commonsense.

Transfusion –associated transmission, i.e. through blood/blood products:


It is common knowledge that we do not acquire HIV if we donate blood at reliable blood banks. Always insist on checking if they are using new disposable or properly sterilized equipment for collecting your precious blood. Remember, screening for HIV will be done on your blood unit as also on all others

You can get HIV/AIDS on receiving transfusion of infected blood, if the blood is not screened. Even when screened there is a possibility that the donor might be in “window period” (The initial phase of HIV infection without detectable antibodies, but with the virus (antigen) transiently present in the blood, is known as window period). This danger exists with the so-called professional donors at high risk situation.

HIV can also be transmitted through contaminated needles or syringes or other skin –piercing implements used for tattooing, acupuncture, etc. We will avoid sharing needles for drug abuse, but how to avoid the others? Insist always that disposable/sterilized syringes and needles are used by the health care providers.

Infected mother to her child

The virus can pass from an infected mother to the child, during pregnancy and childbirth. In our country with rapid heterosexual spread, more women will be infected, thus placing unborn children at high risk situation even before they are born. One advice could be to use condoms all the time and avoid birth. It has to be decided by the couple. What is known is that one in every three HIV-infected women could pass the virus on to infants. If a child is born, breast –feeding is recommended irrespective of HIV status of the baby. This is because of numerous advantages of breast –feeding.

Conclusion:


Just reading of this blog is not the end of the story, we have a long way to go to make AIDS free INDIA or in fact AIDS free world, and we have only way to eradicate the AIDS from the world is “Awareness”. So I request to all my readers that please spread the awareness as much as you can. This is the only vaccine we can use to save our young generation from this life taking disease. Inject this vaccine to everyone so that AIDS could never be able to take any life.

Reference:

  • Challenge of AIDS, by Khorshed M. Pavri,  published by National Book Trust of India.


  • Data analysis and creation of pictures is done by Blogger (Narender Sharma).










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