After exposure to HIV ....................Some Steps..............

WHAT is post-exposure prophylaxis?

Prophylaxis means disease prevention. Post-exposure prophylaxis (or PEP) means taking antiviral medications as soon as possible after exposure to HIV, so that the exposure will not result in HIV infection. These medications are only available with a prescription.

Who should use PEP?
Workplace exposure
PEP has been standard procedure since 1996 for healthcare workers exposed to HIV. Workers start taking medications within a few hours of exposure. Usually the exposure is from a "needle stick", when a health care worker accidentally gets jabbed with a needle containing HIV-infected blood. PEP reduced the rate of HIV infection from workplace exposures by 79 percent. However, some health care workers who take PEP still get HIV infection.

Other exposure
In the last few years, community activists and researchers began asking why PEP shouldn't be used after HIV exposures that are not work-related. People can be exposed to HIV during unsafe sexual activity, when a condom breaks during sex, or if they share needles for injecting drugs. Infants can be exposed if they drink breast milk from an infected woman. In a study of PEP in 400 cases of possible sexual exposure to HIV, not one person became infected with HIV.

Should PEP be used for nonoccupational exposure?
HIV exposure at work is usually a one-time accident. Other HIV exposures may be due to unsafe behaviors that can occur many times. Some people think that PEP might encourage this unsafe behavior if people think that PEP is an easy way to avoid HIV infection.

There are other reasons why PEP might not be a good idea for non-occupational exposure:

* There is no research to show that PEP works for non-occupational exposure. We don't know how soon after exposure to HIV someone has to start PEP.
* PEP is not a "morning after pill". It is a program of several drugs, several times each day, for at least 30 days. PEP costs between $600 and $1,000.
* For best results, you have to take every dose of every PEP medication. Missing doses could mean that you develop HIV infection. It could also allow the virus to develop resistance to the medications. If that happens they would no longer work for you.
* The medications have serious side effects. About 40 percent of health care workers did not complete PEP because of the side effects.

Despite these concerns, a few cities are starting to offer PEP for non-occupational exposure. These programs include counseling to inform and encourage people to avoid exposure to HIV.

How is PEP taken?
PEP should be started as soon as possible after exposure to HIV. The medications used in PEP depend on the exposure to HIV. The following situations are considered serious exposure:

* Exposure to a large amount of blood
* Blood came in contact with cuts or open sores on the skin
* Blood was visible on a needle that stuck someone
* Exposure to blood from someone who has a high viral load (a large amount of virus in the blood).

For serious exposures, the U.S. Public Health Service recommends using a combination of three approved antiviral drugs for four weeks. For less serious exposure, the guidelines recommend four weeks of treatment with two drugs: AZT and 3TC.

In January 2001, the Centers for Disease Control warned against using nevirapine for PEP because of the risk of liver damage. The CDC has not updated its PEP recommendations since 2001.

What are the side effects?
The most common side effects from PEP medications are nausea and generally not feeling well. Other possible side effects include headaches, fatigue, vomiting and diarrhea.

The bottom line
Post-exposure prophylaxis (PEP) is the use of antiviral drugs as soon as possible after exposure to HIV, to prevent HIV infection. PEP can reduce the rate of infection in health care workers exposed to HIV by 79 percent.

The benefits of PEP for non-occupational exposure have not been proven. This use of PEP is controversial because some people fear it will encourage unsafe behaviors.

PEP is a four-week program of two or three antiviral medications, several times a day. The medications have serious side effects that can make it difficult to finish the program. PEP is not 100 percent effective; it can not guarantee that exposure to HIV will not become a case of HIV infection.

STD and HIV/AIDS counselling and testing centres in INDIA:

BANGALORE

ASHA Foundation -- Director Dr. Glory Alexander -- ashaf@satyam.net.in
Please Visit: http://www.ashaf.org/

CHENNAI

Indian Network for People Living With HIV/AIDS(INP+) -- Director Ashok Pillai
Please Visit: http://t8web.lanl.gov/people/rajan/AIDS- india/INP%2b.html

DELHI

HIV Counseling center, Safdarjang Hospital -- Director Dr. Bitra George
Please Visit: http://t8web.lanl.gov/people/rajan/AIDS- india/BGeorge.html

Lok Nayak Jaya Prakash Narayan Hospital, Delhi Gate

Ram Manohar Lohia Hospital, New Delhi

MUMBAI

Humsafar Trust -- Director Ashok Row Kavi
Please Visit: http://www.humsafar.org/


Centres for CD4/CD8 Blood Tests.

# AHMEDABAD

1. VJ Medical College

# BANGALORE

1. NIMHANS

# BHOPAL

1. Gandhi Medical College

# CHANDIGARH

1. Post Graduate Institute of Medical Education and Research (PGI)

# CHENNAI

1. Institute of Thoracic Medicine, Tambaram

# DELHI / NEW DELHI

1. All India Institute of Medical Sciences
2. Dr. Ram Manohar Lohia (RML) Hospital, Near Gole Dakkhana, New Delhi
3. National Institute for Communicable Diseases, 22 Shamnath Marg, Delhi
4. Safdarjung Hospital
5. Lok Nayak Jaya Prakash Narayan Hospital, Delhi Gate

# GOA

1. Medical College, Panjim

# GUWAHATI

1. Medical College

# HYDERABAD

1. Nizam's Institute of Medical Sciences

# IMPHAL

1. JN Medical College

# INDORE

1. Choitram Hospital

# JAIPUR

1. SMS Medical College

# KERALA

1. Tiruvanndapuram Medical College

# KOLKATA

1. Calcutta Medical College
2. School of Tropical Medicine, Medical College, Kolkata
3. City Counselling Centre (Run by Durbar Mahila Samanwaya Committee), 8/1, Bawani Dutta Lane, Kolkata - 700 006
4. Bharuka Public Welfare Trust, Amaader Bari, 63, Rafi Ahmed Kidwai Road, Kolkata
5. Roy & Trivedi, Parkstreet (Beside Petrolpump near Park Street, Thana)
6. Ranbaxy Speciality, Collection Centre, Divine Nursing Home, Beliaghata.

# LUCKNOW

1. KG Medical College
2. Department of Immunilogy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow

# MUMBAI

1. JJ Group of Hospitals
2. KEM Hospital

# MADURAI

1. Madurai Medical College

# PUNE

1. BJ Medical College

# SHIMLA

1. Goverment Medical College

Thanks.........

Some information for all of us..............................

What is STD or STI

A sexually transmitted disease (STD) or infection (STI) is serious, sometimes painful, and can cause a lot of damage. Some STIs infect your sexual and reproductive organs. Others (HIV, hepatitis B, syphilis) cause general body infections. STIs used to be called VDs, or venereal diseases.

An STI is spread during sexual activity. It is spread during vaginal, anal and oral sex. Some STIs ( hiv and hepatitis B) are also spread by contact with infected blood.

Most STI germs need to live in warm, moist areas. That's why they infect the mouth, rectum and sex organs (vagina, vulva, penis and testes).

Most STIs can be cured if you seek treatment. Sometimes you can have an STI with no signs or symptoms. Other times, the symptoms go away on their own. Either way, you still have the STI until you get treated. Some STIs cannot be cured.

Protecting Yourself

Not having sex is the best way to protect yourself from STIs. Having sex with only one uninfected partner who only has sex with you is also safe. Here are other things you can do to protect yourself:

* Use a latex condom (or "rubber") every time for vaginal, anal and oral sex. Condoms will help protect you from STIs much of the time. Both men and women should carry condoms.
* In addition to condoms, use birth control foam, cream or jelly. These kill many STI germs.
* Talk to your partner about past sex partners and about needle drug use. Don't have sex with someone who you think may have an STI.
* Before you have sex, look closely at your partner for any sign of an STI -- a rash, a sore, redness or discharge. If you see anything you are worried about, don't have sex!
* Get checked for an STI every time you have a health exam. If you have more than one sex partner, get examined for an STI any time you think you might be at risk, even if you don't have symptoms.
* Know the signs and symptoms of an STI. If you notice a symptom that worries you, get checked out!
* If you have an STI, your partner(s) must get treated when you do.
* If you have an STI, don't have sex until your doctor says you're cured.


Levels of Risk

HIV and STI Risk Continuum - Nancy Brown, Senior Research Associate, 1997

No Risk (Activities that do not include an exchange of bodily fluids.)
* Holding/hugging
* Dry kissing
* Masturbation (alone)
* Petting
* Foreplay (without bodily fluid exchange)

Probably Safe (Barrier protected activities, or very little bodily fluid contact.)
* French/deep kissing
* Mutual masturbation, with a barrier to prevent fluid exchange
* Oral sex with a condom, dam or plastic wrap
* Analingus (rimming, butt licking) with a dam or plastic wrap
* Vaginal intercourse with a condom
* Anal intercourse with a condom

Risky (Activities during which exchange of bodily fluids might create some danger of transmitting HIV.)
* Vaginal sex, without a condom, with a monogamous partner who tested negative for HIV
* Anal sex, without a condom, with a monogamous partner who tested negative for HIV
* Vaginal sex with a needle user using a condom

High Risk (Unprotected intercourse without a barrier.)
* Oral sex with fluid exchange (no barrier)
* Oral sex without a barrier, with a partner who tested positive for HIV
* Oral sex, without a barrier, with a prostitute
* Vaginal intercourse without a condom
* Vaginal sex, without a condom, with a partner whose sexual history you do not know
* Vaginal sex, without a condom, with a man who has sex with men
* Vaginal sex without a condom, with a partner who has had sex with an IV drug user
* Anal intercourse without a condom
* Analingus (rimming, butt licking) without a dam or plastic wrap

I CAN CHOOSE TO BE SAFE!
I can choose not to have sex. I can choose only to have safer sex and always use a condom correctly. I can choose to say no to alcohol and other drugs. I can talk to my partner about sex and HIV.

REMEMBER IT'S NOT WHO YOU ARE THAT PUTS YOU AT RISK FOR HIV, IT'S WHAT YOU DO.

The above material is taken from “A teen’s guide to HIV and AIDS.” Copyright 1995 Journeyworks Publishing.