HIV AIDS Awareness N Control

Why is AIDS Education Important for Young People?

2008-11-02T03:08:00.001-08:00

The HIV epidemic has been spreading steadily for the past two decades, and now affects every country in the world. Each year, more people die and the number of people living with HIV continues to rise – in spite of the fact that we have developed many proven HIV prevention methods. We now know much more about how HIV is transmitted than we did in the early days of the epidemic, and we know much more about how we can prevent it being transmitted. One of the key means of HIV prevention is education – teaching people about HIV : what it is, what it does, and how people can protect themselves. Over half of the world’s population is now under 25 years old. This age group is more threatened by AIDS than any other; equally it is the group that has more power to fight the epidemic than any other. Education can help to fight HIV, and it must focus on young people.

There are two main reasons that AIDS education for young people is important:

To prevent them from becoming infected.
Young people are often particularly vulnerable to sexually-transmitted HIV, and to HIV infection as a result of drug-use. Young people (15-24 years old) account for half of all new HIV infections worldwide - more than 6,000 become infected with HIV every day ¹. More than a third of all people living with HIV or AIDS are under the age of 25, and almost two-thirds of them are women. In many parts of the world, young people in this age-group are at particularly high risk of HIV infection from unprotected sex, sex between men and IV drug-use because of the very high prevalence rates often found amongst people who engage in these behaviours. Young people are also often especially vulnerable to exploitation that may increase their susceptibility to infection. Even if they are not currently engaging in risk behaviours, as they become older, young people may soon be exposed to situations that put them at risk. Indeed, globally, most young people become sexually active in their teens. The fact that they are – or soon will be – at risk of HIV infection makes young people a crucial target for AIDS education.

To reduce stigma and discrimination.
People who are infected with HIV around the world often suffer terribly from stigma, in that people who are HIV+ are somehow thought to be ‘dirty’, or to have ‘brought it on themselves’ by ‘immoral practices’. They often experience discrimination in terms of housing, medical care, and employment. These experiences, aside from being extremely distressing for HIV+ people, can also have the effect of making people reluctant to be tested for HIV, in case they are found to be HIV+. Stigma and discrimination often starts early – as name-calling amongst children. AIDS education can help to prevent this, halting stigma and discrimination before they have an opportunity to grow.

Different approaches to AIDS education for young people

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Most countries in the world offer teens some sort of sexual health and HIV education in their schools at some stage. AIDS education can also be targeted at young people in non-school environments – through their peers, through the media, and through doctors or their parents. In some countries, individual schools are allowed to determine what AIDS education they will offer. In other countries, this is determined by legislation passed by central government. And in other countries – especially poor ones that are severely affected by HIV – AIDS education is imported by foreign governments, charities and NGOs, that come in to the country and deliver AIDS education as part of a larger package of HIV prevention work.

AIDS education for young people today falls generally into one of two categories: either 'abstinence-only', or 'comprehensive'. These are actually types of sex education, rather than AIDS education specifically - AIDS education in many schools comes as a part of a sex education program, if it occurs at all. The type of AIDS education program that is offered usually depends on the attitudes of those who determine the syllabus content. Right-wing organisations, some religious organisations, and the family-values lobby tend to prefer abstinence-only education, while those who feel that preventing young people from becoming infected with HIV is more important than keeping them ignorant about sexual behaviour prefer comprehensive AIDS education.

A report found that over 80% of abstinence-only curricula contained false or misleading information

Abstinence-only education teaches students that they must say no to sexual activity until they are married. This approach does not teach students anything about how to protect themselves from STDs or HIV, how pregnancy occurs or how to prevent it, and teaches about homosexuality and masturbation only as far as to say that they are wrong. Those who favour this method of education claim that teaching young people about sex will make them want to try it, thus increasing their risk of contracting HIV, amongst other things.

Abstinence-only education is popular in America, especially so now that it has a Republican President. A House of Representatives report at the end of 2004 found that over 80% of abstinence-only curricula contained false or misleading information. ² This is not only a concern for those living in America, but increasingly for the rest of the world, as America exports its HIV-prevention and education attitudes to countries with much higher levels of HIV infection. This is particularly worrying in that abstinence-only programmes have been shown not only to fail to reduce the numbers of sexually transmitted infections and unplanned pregnancies seen in pupils, but recent studies indicate that they might actually be related to an increase in these problems.

Comprehensive AIDS education teaches about sexual abstinence until marriage, and teaches that it is one way of protecting yourself from HIV transmission, STIs and unwanted pregnancy. It also teaches that there are other ways of preventing these things, such as condom use. People who favour this approach take the perspective that, while abstaining from sex until marriage is a good idea and should possibly be encouraged, there will always be some young people that do not choose to abstain – and these people must be provided with information that enables them to protect themselves. This type of education also teaches not only about the dangers of drug use, but also about methods of HIV-prevention that drug users can employ – the use of clean needles, for example.

Abstinence-only and comprehensive AIDS education have been combined to produce abstinence-plus education. This type of education focuses on sexual abstinence until marriage as the preferred method of protection, but also provides information about contraception, sexuality and disease prevention. Many abstinence-only campaigners complain that abstinence-plus and comprehensive education are the same thing, although abstinence-plus educators claim that this type of course contains more focus on sexual abstinence until marriage.

There has been debate for many years over which form of sex education is most effective in terms of preventing underage sex, unwanted pregnancy and STD and HIV transmission, although most studies seem to show that comprehensive sex and AIDS education is at least as effective as abstinence-only – and probably more so. However, currently the trend in America – and which is being exported to much of the developing world – is towards abstinence-only education. If it is as unsuccessful as studies indicate it to be, then we can expect this morality-induced type of education to become responsible for an increase in HIV figures amongst the young, especially in high-prevalence parts of the world to which America has taken its methods.

Fifteen percent of Americans believe that schools should teach only about abstinence from sexual intercourse and should not provide information on how to obtain and use condoms and other contraception. Forty-six percent believe that the most appropriate approach is abstinence-plus ³. Almost half of those surveyed felt that the word ‘abstinence’ included not only sexual intercourse, but ‘passionate kissing’ and ‘masturbation’, too.

What types of AIDS education can be offered outside schools?

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Not all young people are fortunate enough to attend school. This might be for one of a variety of reasons. In some countries, it is necessary to pay for schooling, and poor families may be unable to afford to send a child to school, or may be unable to send all their children to school. Sometimes children will be required to work, making them unavailable for school. In other areas, young people may live in areas where a local school is not accessible. In some situations, young people may have been excluded from school for reasons that might be due to the young person’s behaviour, academic or intellectual abilities, or due to discrimination. Some young people play truant, and will have only very limited attendance. The proportion of young people who attend school differs markedly in various parts of the world.

Clearly, although AIDS education offered through the school might reach many young people, it will not reach all, and other forms of education are required.

One of these is the media. Most young people will, at some time, be exposed to the media. This can include newspapers, television, books, radio, and also traditional media such as street performances or murals. One advantage of media-based AIDS education is that it can target specific groups amongst the population. If the message is to be targeted at young people, then it will be placed in media that are favoured by this audience.

Many countries have tried some form of AIDS education advertisements, films, or announcements. A good example of this is the LoveLife campaign in South Africa, an education program ‘by young people, for young people’. LoveLife used eye-catching posters and billboards to tell young people that sex was fun, but that it could be dangerous, too. The campaign also inserted its message into TV soaps that were popular with young people, and used rap and kwaito music to get its message across.

There are, however, problems with media-based campaigns. It is hard to know to what extent the AIDS information has reached young people, and it is difficult to gain continued funding for initiatives whose success is so hard to measure.

Another way in which young people receive information about sex and HIV is through their peers. This is something that happens anyway to a great extent – many young people receive their first information about sexuality from their friends, although this information is often distorted and inaccurate. This type of peer education can be harnessed, though, and used to convey accurate, targeted information. Peer education is, quite simply, the process by which a group is given information by one of their peers who has received training and accurate information. This is a method often used with groups which have been marginalised. Such groups might have cause to distrust information given to them by an authority figure; if the same information comes from a member of their own group, however, they may well listen. This method of information-provision is often used with such groups as sex workers, the homeless, or drug-users. There is no reason that this method shouldn’t be used with young people, however, and in many parts of the world, it is used. Indeed, it is particularly appropriate for young people who do not attend schools and will not have an opportunity to benefit from an AIDS education curriculum.

AIDS education for the future

Although the debate continues about how much – if any – AIDS education young people should receive, studies continue to show that being informed about the facts and the dangers of HIV and AIDS enables young people to protect themselves and is a crucial tool in the battle against HIV. There is no cure or vaccine for HIV, so prevention is the only way in which we can place any limits on the epidemic. One of the most economical and effective means of HIV prevention is education – involving young people themselves in the HIV prevention effort.

On a global level, America’s disposition towards the promotion of abstinence-only education is cause for concern. America’s spending on HIV prevention around the world exceeds that of any other country, and is to be welcomed – as long as it doesn’t use this money to promote its pro-abstinence-only views of AIDS education. These views – which have been shown to be less successful than comprehensive AIDS education techniques which include an abstinence element – may prove to be damaging to America’s domestic AIDS prevention work ⁴. When exported to high-prevalence countries in Africa, they could prove disastrous.

Whenever educators and planners ask, and listen to young people, they are told time and time again that young people overwhelmingly ask for adequate AIDS education. In most parts of the world, this means more AIDS education than they are presently getting. Young people know that they have the right to the information that enables them to safeguard their lives and those of their sexual partners – they must be listened to, and provided with that information clearly, openly and honestly.

HIV / AIDS and Men Who Have Sex With Men

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Sex between men happens in every part of the world. Some men who have sex with men (MSM) label themselves as gay, others as bisexual, while a large number – particularly outside western countries – simply see themselves as ‘normal’ males who just happen to have sex with other men.

"I’m not gay… I just like having sex with men." - Noun, Cambodia ¹

In the context of the global AIDS epidemic, sex between men is significant because it involves anal sex – a practice that, when no protection is used, carries a higher risk of HIV transmission than unprotected vaginal sex. Historically, AIDS was first discovered among self-identified young gay men in the USA, and throughout the course of the global epidemic, consistently high levels of HIV infection have been found among MSM in many countries.

Organisations representing MSM have also played an active and outspoken role in the response to AIDS. In the USA and the UK for example, gay men’s organisations have raised a great deal of awareness about HIV and AIDS. These groups continue to provide many services to both prevent people becoming infected with HIV, and to help those who are HIV-positive. Another example is Brazil, where groups of gay men exerted a lot of pressure on the government to protect the rights of HIV-positive people in the early years of the nation’s AIDS epidemic.

In many countries however, MSM are not so visible. Sex between men is stigmatised, officially denied and criminalised in various parts of the world. This adds to the vulnerability of MSM, making it difficult to monitor them, and making it near impossible to carry out relevant HIV prevention campaigns in some countries. In places where homosexuality is not tolerated, MSM often hide their same-sex relations from their friends and families to avoid persecution. Many have wives, or have sex with women as well as men, and this means that they may transmit HIV to their female partners if they become infected. The significant impact that HIV is having on MSM is therefore not an isolated problem, but one that is very much linked to countries’ wider HIV epidemics.

MSM and HIV – the global picture

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A centre for men who have sex with men in India

Worldwide, it’s estimated that sex between men accounts for between 5 and 10% of HIV infections. The situation varies between countries however, and in much of the developed world – including the USA, Canada, the UK, Australia and New Zealand – more people have become infected with HIV through male-male sex than through any other transmission route.

Sex between men is also a prominent feature in the spread of HIV in less developed regions. In Latin America, sex between men accounted for a quarter of new HIV infections during 2005. In Asia, HIV prevalence levels among MSM have reached as high as 18% in Andhra Pradesh, India, 15% in Phnom Penh, Cambodia, and 28% in Bangkok, Thailand – figures that are many times higher than those found among these countries’ overall populations. In Japan, around 60% of HIV-positive people are MSM.² In Africa – a region not commonly associated with male-male HIV-transmission – there’s evidence from some countries that transmission through this route is a significant problem. In Senegal for instance, one study recorded that 22% of MSM were living with HIV.³

Although statistics like these give an idea of the impact that AIDS is having on MSM, data is still extremely scarce in many countries. This is largely due to the fact that MSM often have no separate social identity, and are simply counted as part of the general population. It is also due to the reluctance of governments to acknowledge MSM, and to monitor this group.

Another factor blurring statistics is that it’s not always possible to tell how a man became infected. If he is having sex with women as well, he may well report that HIV was transmitted to him from a woman (or even if he is only having sex with other men, he may lie because of stigma). This can distort figures.

From the information that is available, it’s clear that HIV is a significant burden to communities of MSM around the world. But why is this the case? To answer this question, we need to look at the factors that put MSM at risk.

What makes MSM vulnerable to HIV?

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Biological factors

It’s easier for HIV to be transmitted through unprotected anal sex than through unprotected vaginal sex.
If a man has another sexually transmitted infection (STI), this can be an extra biological factor that increases his risk of becoming infected with HIV. STIs are relatively common in some communities of MSM, and because men do not always think – or are not always encouraged – to be tested for STIs that are present rectally, these infections often go undiagnosed and untreated. In many cases, fear of discrimination stops MSM from accessing testing services.

Behavioural factors

Certain behaviours increase MSM’s risk of becoming infected with HIV, such as having multiple sex partners, not using condoms consistently, not learning about HIV or having a complacent or negative attitude towards safer sex.
Alcohol and drugs are a common part of socialising in some communities of MSM. Drink and drugs can make it more likely that people will have unprotected sex and a higher number of sexual partners. In the U.S. for instance, a study in Los Angeles found that MSM who used the drug crystal meth were three times more likely than non-drug using MSM to be infected with HIV.⁴

Social/cultural factors

Some governments and societies are in denial about the fact that sex between men happens, and it is a taboo subject in many cultures. As a result, HIV prevention campaigns often only talk about the risks of heterosexual sex, and there is little appropriate information available to MSM, which can give them the false impression that they are not at risk. There is evidence that this has happened in some Asian countries, for instance.⁵
In countries where sex between men is criminalised, MSM are excluded from sexual health services and might find it hard to access condoms and lubricants to protect themselves from HIV.
A certain proportion of sex between men in most countries is commercial. As with female sex workers, male or transgender sex workers may find it difficult to persuade their clients to use condoms, or may be offered more money to have unprotected sex, increasing the risk that they will become infected with HIV. In some countries there are HIV programmes aimed at female sex workers, but none targeting male sex workers.⁶
In countries where antiretroviral drugs are widely available, a climate of optimism about the effectiveness of this treatment may lead some MSM to take more risks

Responding to HIV among MSM: the challenges

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In the early years of the global AIDS epidemic, it was widely acknowledged that HIV was having a severe impact on MSM in the US and other developed countries where there were visible communities of self-identified gay, lesbian and bisexual people. This led to swift grassroots responses from gay activists, often with support from national governments who realised that carrying out HIV prevention campaigns aimed at gay people was not only the right thing to do on humanitarian grounds, but also something that made sense as a wider public health measure. These early prevention efforts (which included condom promotion and educating men about AIDS) were very successful, and helped to reduce the number of MSM becoming infected with HIV in a number of countries.

HIV prevention poster aimed at MSM in New Zealand

In recent years however, the impact of these interventions has leveled off and HIV is becoming common among MSM in many developed countries. It has also become increasingly clear that there is a desperate need for HIV prevention initiatives aimed at MSM in developing regions such as Asia, Latin America and Africa. However, very few countries in these regions are making sufficient (if any) efforts to stem rising rates of HIV among MSM. Globally, fewer than one in twenty MSM have access to appropriate HIV prevention, treatment, care and support services.⁸

A major reason for this shortcoming is the fact that many countries (87 according to a 2007 report ⁹) have laws banning same sex relations. Where such laws are in place, governments are unlikely to promote any sort of HIV interventions aimed at MSM. Groups or individuals who do try to carry out such campaigns, as much as MSM themselves, may face violence or arrest:

"The police caught me and hit me. They didn’t even give me a chance to explain... I said I was working for HIV/AIDS prevention. They asked to see my ID card but I had forgotten it that day. They took me to jail. After I promised that I would never go to cruising spots again, they let me go." - HIV prevention worker working with MSM in Bangladesh ¹⁰

This kind of discrimination from authorities is sometimes also apparent when MSM who are already living with HIV try to access testing or treatment facilities:

“Our biggest problems are the police and doctors. Many [MSM] people we work with are poor – daily wage-earners – and cannot afford expensive private doctors. When they go to a government health clinic, the doctors taunt them about their sexual preferences. Many prefer to remain untreated rather than suffer discrimination and humiliation." - Christopher Jayakumar, head of the Andhra Pradesh Male Minorities Association, India¹¹

Discrimination such as this stops MSM from revealing their same-sex relations, and may force them to meet potential partners in places that are hidden from the general public. This can make it very difficult to reach them with HIV prevention campaigns.

Experts argue that governments and societies need to adopt a less discriminatory approach if HIV prevention efforts aimed at MSM are to work. This includes repealing laws that criminalise sex between men, introducing laws to reduce human rights violations, and making greater efforts to change public perceptions of MSM. Even in countries where the rights of MSM are legally respected, there is generally a greater need for more commitment towards tackling the problem by donors and governments, as the amount of money put towards campaigns aimed at MSM is often disproportionate to the scale of the problem.

Crucially, more research into the impact of HIV on MSM – particularly in developing countries – would lead to a much greater understanding of the situation and make it much easier to take appropriate action.

"The frightening truth is that, in many parts of the world, we simply do not know how bad the epidemics among MSM groups may be… transmission among MSM is still not tracked in most countries, resulting in a significant research gap. More research is urgently needed to inform more effective HIV prevention efforts.” - Dr. Chris Beyrer, director of the Johns Hopkins Fogarty AIDS International Training and Research Program ¹²

HIV prevention that works

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When MSM are targeted by HIV prevention campaigns, it can be extremely effective. One study of 33 behavioural interventions aimed at MSM around the world showed that these efforts reduced the number of men having unprotected anal sex by one quarter, and increased condom use by 61%.¹³

One of the most important prevention responses is to make high-quality condoms, along with water-based lubricants, available and accessible to MSM (if suitably strong condoms are not used then they may break, and if oil-based lubricants are used they can damage condoms). In some countries gay bars and other known meeting places for MSM, such as bathhouses, provide and promote condoms and lubricants. Successful prevention work has also been carried out by outreach workers and peer educators, who meet with MSM personally and provide them with condoms, lubricants, and information.

Prevention work with men who have sex with men in India

As is the case with sex workers (another marginalised group who are heavily affected by HIV), many of the most successful programmes aimed at MSM empower this group and actively involve them.

"Empowering MSM and other marginalized groups to protect themselves from HIV is one of the world's most urgent health priorities." - Peter Piot, UNAIDS ¹⁴

Even in countries where homosexuality is not widely recognised, and where HIV services for gay men are severely lacking, groups of MSM have made a substantial difference in some areas. In India for instance, the use of peers to distribute condoms among MSM has resulted in a significant increase in condom use in the city of Mumbai, where a study found that more than two-thirds of condoms used by MSM were those handed out by peer educators.¹⁵

In some countries it has been understood that fighting prejudice and changing public attitudes towards MSM are important prevention measures. In Mexico, the government has appointed Jorge Saavedra, an openly gay, HIV-positive man, as head of its national AIDS council. He has been the driving force behind a large nationwide media campaign to reduce homophobia.¹⁶

Another successful approach has been to introduce ‘safe spaces’ where MSM can meet, talk openly and receive sexual health services, including testing facilities and treatment. MSM have specific STI-related needs but often feel uncomfortable going to conventional public sector health services with their problems.¹⁷

The internet can be another effective means of reaching out to MSM, as increasing numbers of MSM are meeting online – not just in developed nations, but also in countries such as the Philippines¹⁸ and Peru¹⁹. Some websites used by MSM place health advisors in chatrooms, display animated characters to educate people about HIV, and encourage users to be open about their HIV-status.

Introduction to the AIDS epidemic

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The history of AIDS is a short one. As recently as the 1970s, no one was aware of this deadly illness. Since then the global AIDS epidemic has become one of the greatest threats to human health and development. At the same time, much has been learnt about the science of AIDS, as well as how to prevent and treat the disease.

The global picture

Statistics for the end of 2007 indicate that around 33.2 million people are living with HIV, the virus that causes AIDS. Each year around 2.5 million more people become infected with HIV and 2.1 million die of AIDS.¹

Although HIV and AIDS are found in all parts of the world, some areas are more afflicted than others. The worst affected region is sub-Saharan Africa, where in a few countries more than one in five adults is infected with HIV. The epidemic is spreading most rapidly in Eastern Europe and Central Asia, where the number of people living with HIV increased 150% between 2001 and 2007.²

People living with HIV around the world: a South African child; a Guatemalan mother; American activist and writer Larry Kramer

Children affected by AIDS

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Because every child today is growing up in a world where AIDS is a devastating reality, some people say that every child is affected by the epidemic, whether they are infected or not. Other talk specifically about children who have been orphaned by AIDS, or those who are HIV-positive. Regardless of how people look at the situation, it is clear that there are many ways in which a child can be affected by HIV, and that it is not only those who are infected that are suffering as a result of the epidemic.

HIV can damage a child’s life in three main ways: through its effects directly on the child, on that child’s family, and on the community that the child is growing up in.

The direct effects of HIV on children

Many children are themselves infected with HIV

The effects of HIV on a child’s family

Children live with family members who are infected with HIV.
Children act as carers for sick parents who have AIDS.
Many children have lost one or both parents to AIDS, and are orphaned.
An increasing number of households are headed by children, as AIDS erodes traditional community support systems.
Children end up being their family’s principal wage earners, as AIDS prevents adults from working, and creates expensive medical bills.

The effects of HIV on a child’s community

As AIDS ravages a community, schools lose teachers and children are unable to access education.
Doctors and nurses die, and children find it difficult to gain care for childhood diseases.
Children may lose their friends to AIDS.
Children who have HIV in their family may be stigmatized and affected by discrimination.

Children, HIV & AIDS

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Becoming infected with HIV

The problems for children

Mother-to-child-transmission of HIV accounts for the vast majority of children who are infected with HIV. If a woman already has HIV then her baby may become infected during pregnancy or delivery. HIV can also be transmitted through breast-milk.

An HIV+ mother with her HIV+ child in the township of Joza

Aside from mother-to-child transmission, some children are exposed to HIV in medical settings; for instance, through needles that have not been sterilised or blood transfusions where infected blood is used. In wealthier countries this problem has virtually been eliminated, but in resource-poor communities it is still an issue. For older children, sexual activity and drug use present a risk.

It is well known that many young people start to have sex before they have reached the age of consent, and in some cases children make the decision to have sex of their own accord. In other cases, however, children are exposed to HIV through sexual abuse and rape. This is a significant problem in many areas. For instance, in parts of Africa, the myth that HIV can be cured through sex with a virgin has led to a large number of rapes – sometimes of very young children – by infected men.⁸ In some cases, young children are coerced into sex work, which can put them at a very high risk of becoming infected with HIV.

Helping children

The main way to stop children becoming infected is to prevent mother-to-child-transmission. Mother to child transmission of HIV is almost entirely avoidable, given appropriate interventions. These measures (which include the giving of antiretroviral drugs to a mother during pregnancy, and to her child once it is born) can reduce the risk of mother-to-child transmission from 20-45% to less than 2%. In developed countries, such interventions have minimised the number of children being born with HIV.

Unfortunately, prevention of mother-to-child-transmission (PMTCT) services fail to reach most women in resource-poor countries. In 2006, only 23% of HIV-infected pregnant women in low- and middle-income countries received drugs to protect their babies from infection.⁹ Reasons for this lack of coverage are discussed in our PMTCT worldwide page, while our Stop AIDS in Children campaign calls for rapid improvement.

The use of sterile medical equipment and screened blood products can help to prevent children becoming infected through medical transmission. In Romania, more than 10,000 new babies and young children were infected with HIV from contaminated injections and unscreened blood transfusions between 1987 and 1991. This country serves to illustrate not only how vulnerable children are to infection in a medical setting, but also how a country can respond to these problems. The large number of HIV-positive children in Romania prompted the government to roll out antiretroviral treatment, which today reaches almost all of those in need. Sterile medical equipment is used, and blood-products are now screened for HIV.¹⁰

In regards to preventing infection through sexual activity and drug use, the most effective thing that can be done is to prevent children from having sex or from using drugs – things that are illegal anyway in most countries.

This, however, is not always possible, and legislators and educators need to accept that some children are always going to have sex or use drugs, even if they are told not to. All children and young people should receive effective sexual health and HIV education so that they know how to avoid pregnancy and sexually transmitted infections, including HIV. Educators must also accept that children are likely to be exposed to drugs at some point in their lives - and that they therefore need to be taught how to protect themselves from HIV infection and other dangers associated with drug use.

Children infected with HIV

The problems for children living with HIV

Once a child is infected with HIV, they face a high chance of illness and death, unless they can successfully be provided with treatment. HIV treatment in children slows the progress of HIV infection and allows infected children to live much longer, healthier lives. Sadly, the vast majority of children who could be benefiting from this therapy – an estimated 90% – are not receiving it.¹¹ A major problem is that few appropriate drugs are available. Young children ideally need to be given drugs in the form of syrups or powders, because they cannot swallow tablets. Unfortunately, most of the drugs that work well in children are only available as tablets. As a result, carers are often forced to break adult tablets into smaller doses for their children, which can lead to children being given too little or too much of a drug.

There are numerous other problems that are stopping children from accessing antiretroviral drugs – for instance, high drug prices and the lack of healthcare workers trained to treat children. Our HIV treatment and children: the problems page looks at these problems, and what needs to be done.

Another major problem for children living with HIV is childhood illnesses, such as mumps and chickenpox. These illnesses can affect all children, but since children living with HIV have such weak immune systems they may find that these illnesses are more frequent, last longer, and do not respond as well to treatment.¹² Opportunistic infections, such as Tuberculosis and PCP (a form of pneumonia), are also a serious risk to the health of children living with HIV.

Helping children living with HIV

The first step to helping a child who is infected with HIV is to diagnose them through HIV testing. It is important that HIV-positive children are diagnosed as quickly as possible, so that – where feasible – they can be provided with appropriate medication and care. However, testing children for HIV can be complicated, especially for those recently born to HIV-positive mothers. Antibody tests, which are used to diagnose HIV in adults, are ineffective in children below the age of 18 months. Instead, children below this age are usually diagnosed through polymerase chain reaction (PCR) testing and other specialist techniques. Since these methods require expensive laboratory equipment and specially trained staff, they are generally unobtainable in the resource-poor areas where they are needed the most.¹³

Recently, the use of ‘dried blood spot’ testing has brought some hope to the situation. This method allows small samples of blood to be collected on paper, and sent away to a laboratory where PCR (or similar testing) is available. Unlike testing methods that use liquid samples, dried blood spots can be stored for a long time and easily transported, so even if the nearest laboratory is some distance away, it may still be possible to use PCR technology on a sample of a child’s blood.

Once a child has been diagnosed, they ideally need to be carefully monitored and provided with antiretroviral drugs. Even in resource-poor areas where antiretroviral syrups and powders are unavailable, studies suggest that breaking down adult tablets into smaller doses can work effectively – although this should only really be seen as a last resort.¹⁴ Children who are treated successfully may be able to live relatively health lives. To learn about how antiretroviral treatment can be successfully administered to children, visit our page on HIV treatment in children.

Childhood illnesses can be avoided through vaccines, immunisations and good nutrition. Most routine-vaccines are safe in children living with HIV and are strongly recommended, although ‘live vaccines’ (where a weakened or killed version of a virus is injected, so that the body builds up an immunity to it) are not generally considered safe.¹⁵ ¹⁶

Opportunistic infections can be prevented using drugs such as cotrimoxazole: a cheap antibiotic that has been proven to significantly reduce the rate of illness and death among HIV-positive children.¹⁷ Countless lives could be saved if cotrimoxazole were made more widely available, but at the moment it is estimated that around four million children who could be benefiting from the drug are not receiving it.¹⁸

Children living with HIV have many practical and material needs, but they also have social, emotional and psychological needs. It is therefore important that emotional care is provided to all children affected by HIV, including those who have lost parents or relatives to AIDS. There are particular stages of a HIV-positive child’s life when meeting these needs can be particularly important: the times when they are first diagnosed, start to receive treatment, have to deal with discrimination, experience problems adhering to drugs, or have to deal with end-of-life issues. They may also face trauma as a result of one or both of their parents dying from AIDS, since there is a highly likelihood that their mother, at least, is infected.

It is ultimately up to the families, friends, caregivers and healthcare workers involved to provide emotional support, but governments and organisations also have a responsibility to address the wider problems that may prevent communities from meeting children’s needs. Through services, programmes and protective legislation, governments can ensure that families and carers have the security that they need to care for children.¹⁹

The effects of HIV on children’s families

The problems

An HIV+ boy and his family members

With an estimated 37.2 million adults living with HIV around the world, large numbers of children have family members that are living with HIV, or who have died of AIDS. These children may themselves experience the discrimination that is often associated with HIV. They may also have to care for a sick parent or relative, and may have to give up school to become the principle wage-earner for the family. When adults fall sick, food still needs to be provided – and the burden of earning money usually falls on the oldest child.

One of the harshest effects of the global AIDS epidemic is the number of orphans it has created, and continues to create. By the end of 2005, it is estimated that more than 15 million children had lost one or more of their parents as a result of AIDS. Some AIDS orphans are adopted by grandparents or other extended family-members, but many are left without any support. Child-headed households as a result of AIDS are common in some areas, with older children fending for their siblings and themselves. See our AIDS orphans page to learn more.

Helping families

There are two main things that can be done to help families cope with the burden of HIV. The first is to provide treatment to family-members who are infected. Although antiretroviral drugs are still not widely available in many resource-poor areas, a child’s family-members may be able to reach a clinic or hospital that can provide these drugs. Treatment access is slowly improving in resource-poor countries, but much more money and effort will be needed if the situation is to improve. In Sub-Saharan Africa, for instance, only around 23% of people in need of treatment are receiving it.²⁰

The second thing that can be done is to provide family members who are not infected with HIV with knowledge and resources – such as condoms – that can help them to stay uninfected. HIV prevention campaigns, whether run by the government, local groups, or international organisations, can help to bring these things to families and their communities.

Children who have lost their parents as a result of AIDS may be in particular need of support and care. Many organisations focus on providing care and support to AIDS orphans and other children made vulnerable by HIV and AIDS. This may involve providing food, clothing, help with looking after siblings or sick family members, and help to ensure that children are able to attend school. Ideally, campaigns need to prevent such children becoming orphaned in the first place, by keeping their parents alive through treatment. Parents who are receiving antiretroviral drugs can work, earn a wage and provide financial support and emotional care for their children.

The effects of HIV on children’s communities

The problems

HIV and AIDS have held back development and economic growth in many of the world’s poorest communities, and have caused practical problems and emotional distress to large networks of families, friends and neighbours. For the children growing up in these communities – even those who are uninfected, and who have no family members that are infected – HIV and AIDS are negatively affecting their lives.

In areas where there is a high rate of sickness and mortality due to HIV and AIDS, it is often difficult to provide essential services to children. One of the most important services that children need is healthcare. In areas heavily affected by AIDS, hospitals are often overwhelmed by the large number of patients that they have to look after. In many cases these hospitals have lost staff to AIDS, making it even more difficult for them to cope. In this situation, it is hard to provide children with adequate medical care, whatever they need treatment for.

Another essential service for children is schooling. As with healthcare services, many schools have deteriorated as a result of AIDS, as teachers and pupils become sick and die. This results in a poorer education for all children in affected areas. In turn, those children may face a higher risk of becoming infected with HIV in the future, because effective schooling can help children to become more aware of HIV and give them the confidence to take responsibility for their sexual choices. See our HIV, AIDS and schools page to learn more about this problem.

There are numerous other ways in which a child’s life can be changed by the affects that AIDS is having on their community. For people living in countries where HIV is not widespread, it can be hard to appreciate how severely some communities have been damaged by the epidemic – but the reality is that many children are now living in towns and villages where a lot of houses are left empty as a result of AIDS.

Helping communities

As with families, helping communities to overcome HIV and AIDS is essentially a twofold process – HIV prevention needs to be carried out to stop new infections occurring, and antiretroviral treatment needs to be provided to those that need it, so that they can stay healthy and fulfil their role in the community.

Crowd watching an AIDS education event near Lundazi

Many groups and organisations carry out HIV prevention programmes on a community level, educating people about how to avoid infection and supplying condoms. Usually, these campaigns also attempt to address the stigma and discrimination surrounding HIV, which can stop communities discussing AIDS openly and frankly. There are all sorts of ways that prevention messages can be brought to communities: billboards, theatrical productions, HIV education in schools, and radio programmes are some examples. Children who live in areas where prevention campaigns are being carried out are more likely to be aware of HIV as they grow up.

Increasing the provision of antiretroviral treatment in a community can help HIV-positive adults to work and live relatively normal lives. This can allow HIV-positive adults who are in a position where children are depending on them – whether parents, doctors, nurses, or teachers – to live up to this responsibility. In communities, as in the family, it is always better to keep children’s family members alive than to provide them with support after that relative has died. To read more about international efforts to improve access to antiretroviral drugs in resource-poor countries, see our providing treatment for millions page.

What needs to be done?

It is clear that much more needs to be done, especially in resource-poor countries. Many children are dying, whilst millions more are experiencing the scars that AIDS can leave on their lives – almost all of which are avoidable. Medical treatment is such that, in a developed country, a woman living with HIV can now be almost certain that her child will not be infected - and yet there are still delays in making the appropriate tests and drugs available around the world.

If infected with HIV, children can be effectively treated, and, given this treatment, can have longer, healthier lives – yet they continue to die, because the antiretroviral drugs are still not widely available in many countries. Developing countries need not only the drugs to treat children, but also specialist training for staff, and funding to enable treatment and ongoing care. The world's political leaders and decision-makers already have these tools to save children from needless suffering, but they are still not reaching most of those who need them.

HIV Prevention

2008-11-02T02:53:00.000-08:00

Injecting drug users (IDUs) have been among the groups most affected by HIV & AIDS since the epidemic began. Sharing syringes is a very efficient way to transmit blood-borne viruses such as HIV, which can spread rapidly through IDU populations. The sharing of needles and “works” (syringes, water, mixing spoon, etc.) is thought to be three times more likely to transmit HIV than sexual intercourse. ¹

Injecting drug use

Recreational drug use is illegal in most parts of the world and attitudes to HIV prevention for IDUs vary significantly. It is estimated that there were 13.2 million injecting drug users globally at the end of 2003. ² Around 10% of HIV infections globally are directly a result of transmission through injection. ³ The worst affected areas for infection through contaminated needles are Eastern Europe, Central Asia, most of Southern Asia, North Africa, Iran, Pakistan, Nepal, and parts of Latin America. ⁴

It should be noted that injecting drug use is not the only form of recreational drug use that increases the risk of HIV transmission; non-injecting drug users can be exposed to the virus through unsafe sexual behaviour whilst intoxicated, as explained in our recreational drug use & HIV page.

Rates of injecting drug use and HIV in selected countries

Country	Proportion of population who are IDUs (%)	HIV prevalence (%) in IDUs
Country	Proportion of population who are IDUs (%)	National	Capital city	Other sites
Argentina	0.17	18.8-39.2	7.6-80.0	60.0-61.0
Brazil	0.69	28.0-42.0	15.0-34.0	18.0-48.5
Bermuda & Caymans	4.93	-	-	-
Canada	0.61	14.5-47.9	7.1-23.5	1.1-41.0
China	0.23	0.0-80.0*	-	1.0-84.0*
Estonia	2.05	13.0	41.0	-
France	0.26	13.6-19.3	-	13.7
India	0.21	1.3-68.4	44.5-45.0	2.0-81.0
Indonesia	0.42	15.0-47.0	14.9-40.0	16.0-56.0
Italy	0.64	10.0-65.6	-	0.6-32.8
Libya	0.23	0.5-59.4	-	-
Malaysia	1.47	10.0-40.0	-	18.0
Myanmar	0.71	37.1-63.0	37-38.9	7.0-92.3
Poland	1.45	6.3-11.0	16.9	-
Portugal	0.45	13.6	8.3-41.3	0.0-37.0
Puerto Rico	0.59	-	42.4-55.2	-
Russia	1.96	0.8-4.8	0.12-28.3	0.0-64.5
Spain	1.06	15.2-66.5	-	1.3-48.3
United Kingdom	0.26	0.8	2.9-4.5	0.2-3.3
USA	0.67	-	-	0.4-42.0

* Excluding Hong Kong and Macao

Around 25% of all injecting drug users live in South and South-east Asia, and a further 18% in East Asia. Both China and India are home to more than a million IDUs. Asia has the world's highest rates of HIV infection among IDUs. By 1999, drug-dependent individuals comprised about 77% of HIV infections in Malaysia and 69% in China, and 66% of AIDS cases in Viet Nam.

A further 24% of injecting drug users are found in Eastern Europe and Central Asia. There are around 2 million in Russia, 397,000 in Ukraine and 174,000 in Kazakhstan. IDUs account for 82% of all HIV/AIDS cases in Central Europe and Former Soviet Union states.

North America and Latin America respectively account for 10.6% and 7.6% of injecting drug users. There are around 1.3 million in the USA, 800,000 in Brazil and 153,000 in Canada.

Around 9.4% of IDUs live in Western Europe, where populations above 200,000 exist in Germany, Italy and Spain.

Types of prevention

There are three approaches to HIV prevention among IDUs. Supply reduction and demand reduction are the most favoured and commonly used, relying on enforcement and education to prevent drug use. The third approach, known as ‘harm reduction’, was pioneered in Western Europe in the mid 1980s, but is still considered controversial in many parts of the world. Evidence, however, suggests that a combination of all three methods of prevention is the most effective way to decrease HIV infection through injecting drug use.

Supply reduction

This method of prevention is practised globally against all forms of illegal drug use. It focuses on halting the drug supply routes by:

Illegal drugs seized by the U.S. Drug

Enforcement Administration

Seizing illegal drugs through customs operations.
Arresting drug trafficking groups to break up supply routes through law enforcement.
Encouraging producers of drug crops, such as opium poppies, to grow alternative crops.

When used alongside the other two approaches, supply reduction can be effective in limiting the quantity of drugs available on the street. This results in higher street prices, which may dissuade some people from drug use.

Demand reduction

This is a popular and effective form of prevention that promotes a healthy lifestyle free from drug use. It aims to decrease the demand for drugs, and may be achieved by:

Education in schools about the damaging effects of drug use.
Reaching out to the general population through awareness campaigns.
The rehabilitation of drug users through clinics, using techniques such as methadone substitution treatment to decrease dependency on narcotics such as heroin. This approach also contributes to harm reduction.

Harm reduction

Needle exchange pack

Harm reduction focuses solely on minimising harm caused through drug use and preventing the spread of HIV, without condoning or prohibiting continued drug use. It defines policies, programmes, services and actions that work to reduce drug-related health, social and economic harms to individuals, communities and society that are associated with the use of drugs.

“Harm reduction is pragmatic: it accepts that the use of drugs is a common and enduring feature of human experience, and acknowledges that, while carrying risks, drug use provides the user with benefits that must be taken into account if responses to drug use are to be effective.

“Harm reduction recognises that containment and reduction of drug-related harms is a more feasible option than efforts to eliminate drug use entirely. Harm reduction does not focus on abstinence: although harm reduction supports those who seek to moderate or reduce their drug use, it neither excludes nor presumes a treatment goal of abstinence.” - UK Harm Reduction Alliance. ⁵

A harm reduction approach will often include the following:

Needle exchange programmes provide places where drugs users can exchange used needles and syringes for new, clean ones, and so reduce the risk of HIV infection through sharing equipment. They may also provide other treatment and care services such as HIV testing, referral routes to rehabilitation programmes, counselling, and condoms.

Rehabilitation clinics provide many services such as counselling and detoxification treatments to help drug users to stabilise their behaviour. Methadone or buprenorphine substitution treatment, prescribed in liquid or pill form, removes the risk of HIV infection through needle use. This detoxification approach gives users a chance to manage the physical and psychological effects that occur through prolonged opioid use, whilst gradually decreasing dependency. Substitution treatment also stops IDUs from using dangerous street drugs that can be contaminated.

Community-based outreach programmes work with IDUs to distribute clean equipment, promote condom use and provide information about prevention and rehabilitation. Injecting communities are often secretive and distrustful of authorities. Outreach programmes focus on accessing these hidden groups, opening an important route to providing support. In some cases, former IDUs are recruited and trained as peer-outreach workers. Some IDUs are likely to be involved in the commercial sex-trade to fund expensive drug addiction, so sexual health information and condom promotion are key factors in preventing HIV transmission through other routes.

Some harm reduction programmes also include safe injection rooms that provide services for problem IDUs who are unable to change their behaviour through other harm reduction treatments. These services aim to “medicalise” injecting drug use by giving it a cold, sterile image and studies have shown them to be effective in making opioid use unattractive to young potential users.

What needs to be done?

2008-11-02T02:52:00.000-08:00

The ABC OF HIV Prevention

2008-11-02T02:50:00.000-08:00

HIV can be transmitted in the sexual fluids, blood or breast milk of an infected person. HIV prevention therefore involves a wide range of activities including prevention of mother-to-child transmission, harm reduction for injecting drug users, and precautions for health care workers.

This page looks at strategies for preventing sexual transmission of HIV, and in particular the much-discussed "ABC" approach. So what exactly is the ABC approach, why does it cause such controversy, and does it work?

What exactly is the ABC approach?

A roadside sign in Botswana - late 1990s

One of the difficulties with the ABC approach is the lack of a clear definition. The slogan seems to have first been adopted by the Botswana government in the late 1990s. Seen on billboards around the country it exalted the fact that:

Avoiding AIDS as easy as...

A bstain
B e faithful
C ondomise

Was this saying something new?

Since the late 1980s it had been known that individuals could take action to either reduce or avoid altogether the risk of becoming infected with HIV through sexual transmission.

The risk could be avoided altogether by avoiding any sexual activities that could cause transmission of HIV (i.e. Abstain).

The risk could also be reduced, through avoiding sexual intercourse other than with a mutually faithful uninfected partner (i.e. Be faithful) or through the correct and consistent use of condoms (i.e. Condomise).

So Botswana hadn't really developed a new approach to HIV prevention, but rather a new way of putting across known risk reduction and risk avoidance strategies.

Was this controversial?

The ABC definition adopted by Botswana was not particularly controversial. It was primarily a slogan used as part of a general public AIDS awareness campaign, and it did not attempt to define the circumstances under which the component parts of A, B and C would be promoted and whom they would be promoted to.

But since the use of this slogan in Botswana there have been other variations which have more specific definitions, most notably those adopted by the US-funded PEPFAR initiative, and others adopted by UNAIDS.

What is the PEPFAR definition of ABC?

PEPFAR follows an ABC strategy through "population-specific interventions" that emphasise:

A bstinence for youth, including the delay of sexual debut and abstinence until marriage
B eing tested for HIV and being faithful in marriage and monogamous relationships
C orrect and consistent use of condoms for those who practice high-risk behaviours.

Those who practice high-risk behaviours include "prostitutes, sexually active discordant couples [in which one partner is known to have HIV], substance abusers, and others". The PEPFAR definition does not include the promotion of condoms to young people in general.¹ However, PEPFAR does say that its funds may be used to support programmes that deliver age-appropriate "ABC information" for young people, provided they are informed about failure rates of condoms, and provided the programmes do not appear to present abstinence and condom use as equally viable, alternative choices.²

And what is the UNAIDS definition of ABC?

For UNAIDS, ABC means:

A bstinence or delaying first sex
B eing safer by being faithful to one partner or by reducing the number of sexual partners
C orrect and consistent use of condoms for sexually active young people, couples in which one partner is HIV-positive, sex workers and their clients, and anyone engaging in sexual activity with partners who may have been at risk of HIV exposure.³

So what is the controversy about?

The controversy arises from the differences between these two definitions of ABC, and in particular the fact that with the PEPFAR definition there is no promotion of condoms for young people (or anyone else outside the "high risk groups"), and that with abstinence the emphasis is on abstaining until marriage.

If, in countries where there is a high prevalence of HIV infection resulting from sexual transmission, young people delay having sex for the first time, then this risk avoidance will indeed result in them avoiding infection whilst they are adopting this approach.

However, abstinence until marriage does not always ensure safety, because marriage in itself provides no protection from infection. Many people are unsure of the HIV status of their partners, and those who are faithful cannot be certain that their partner is maintaining the same commitment.

Abstinence is not a realistic option for the millions of women and girls who are in abusive relationships, or those who have been taught always to obey men. People who do not abstain should do everything possible to reduce risk, including using condoms.

“condoms, when distributed with educational materials as part of a comprehensive prevention package, have been shown to significantly lower sexual risk and activity, both among those already sexually active and those who are not." - UNAIDS, October 2004.⁴”

A large number of AIDS organisations and experts have voiced concern that PEPFAR is putting too much emphasis on abstinence until marriage, and is not doing enough to make young people aware that condoms, if used correctly and consistently, are highly effective at preventing HIV infection.

Why is Uganda so often mentioned in relation to the ABC of HIV prevention?

The ABC approach to HIV prevention is often said to have started in Uganda, and it is said by some people to have been the reason for Uganda's unique success in reducing its HIV prevalence (defined as the proportion of adults living with HIV).

What happened in Uganda?

When HIV was rapidly spreading through the population of Uganda in the late 1980s, President Yoweri Museveni, unlike most other African leaders at the time, recognised the danger and took swift action showing forceful leadership. Uganda's response was powerful and wide-ranging. The government launched an aggressive media campaign involving posters, radio messages and rallies; they trained teachers to begin effective HIV and AIDS education; and - most importantly - they mobilised community leaders, churches and indeed the public in general.

The government worked alongside many independent organisations, using different messages to address different groups of people according to their needs as well as their ability to respond. Young people were encouraged to wait before first having sex, or to return to abstinence if they were not virgins. All sexually active people were given the message of "zero grazing", which meant staying with regular partners and not having casual sex. Those who did not abstain were encouraged to use condoms, which were promoted to the population as a whole.

In order to encourage people to take up such strategies - and to make them effective - action was taken to encourage candid discussion of HIV and AIDS, to reduce stigma, to better the status of women, to improve testing facilities, to treat other sexually transmitted infections and to provide better care for those already infected. Fear was also a part of the strategy, but the campaigns explained how to avoid or reduce risk and so not be overtaken by fear.

There is no evidence of the term "ABC" being used in Uganda's campaigns at this time, although they did incorporate some elements of abstinence, being faithful and using condoms.

What worked in Uganda?

What appears to have worked in Uganda was a combination of risk avoidance and risk reduction approaches. These resulted in a fall in the annual number of new infections between the late 1980s and mid 1990s, which in turn led to a reduction in HIV prevalence. In later years, an increase in the death rate probably made a contribution to further declines in prevalence, while the number of new infections remained more or less unchanged.

What has been particularly important in Uganda has been the combination of messages and approaches that have been used, including the widespread promotion and distribution of condoms. During the 1990s, schemes funded by USAID and other donors greatly increased condom use.⁵

“The ABC approach in Uganda was and still is more than just abstinence and needs to be balanced without any emphasis on one aspect. Neither 'A' nor 'B' nor 'C' on its own can provide the answer to reducing risk of infection that is practical for every member of the population.” - Dr Stella Talisuna, March 2005 -⁶

How does this relate to PEPFAR?

For a while after being popularised in Botswana in the late 1990s, the term ABC of HIV prevention was little used elsewhere. But then, in December 2002, it was decided that America's approach to the prevention of sexual HIV transmission would in future be described as ABC. This decision appears to have been largely based on, and is now being promoted and is justified on, the basis that ABC was what worked in Uganda. But the simple catchphrase "ABC" cannot sufficiently describe what happened in Uganda.

Without doubt measures to promote abstinence, fidelity and condom use are all essential to any comprehensive HIV prevention programme - but they alone are not enough. Also required is strong political commitment, frank and open discourse, community mobilisation and involvement of local organisations and businesses, as well as practical measures such as HIV testing and counselling, treatment of STIs, campaigns to combat stigma and discrimination, and efforts to promote gender equality. It seems misleading and inappropriate to use the example of Uganda, which employed such a comprehensive programme, to justify or promote any one particular defintion of "ABC"

What is AIDS??

2008-11-02T02:48:00.002-08:00

People have been warned about HIV and AIDS for over twenty years now. AIDS has already killed millions of people, millions more continue to become infected with HIV, and there's no cure – so AIDS will be around for a while yet.

AIDS is one of the biggest problems facing the world today and nobody is beyond its reach. Everyone should know the basic facts about AIDS.

What is AIDS?

AIDS is a medical condition. People develop AIDS because HIV has damaged their natural defences against disease.

What is HIV?

HIV (Human Immunodeficiency Virus)

HIV is a virus. Viruses infect the cells that make up the human body and replicate (make new copies of themselves) within those cells. A virus can also damage human cells, which is one of the things that can make a person ill.

HIV can be passed from one person to another. Someone can become infected with HIV through contact with the bodily fluids of someone who already has HIV.

HIV stands for the 'Human Immunodeficiency Virus'. Someone who is diagnosed as infected with HIV is said to be 'HIV+' or 'HIV positive'.

Why is HIV dangerous?

The immune system is a group of cells and organs that protect your body by fighting disease. The human immune system usually finds and kills viruses fairly quickly.

So if the body's immune system attacks and kills viruses, what's the problem?

Different viruses attack different parts of the body - some may attack the skin, others the lungs, and so on. The common cold is caused by a virus. What makes HIV so dangerous is that it attacks the immune system itself - the very thing that would normally get rid of a virus. It particularly attacks a special type of immune system cell known as a CD4 lymphocyte.

HIV has a number of tricks that help it to evade the body's defences, including very rapid mutation. This means that once HIV has taken hold, the immune system can never fully get rid of it.

There isn't any way to tell just by looking if someone's been infected by HIV. In fact a person infected with HIV may look and feel perfectly well for many years and may not know that they are infected. But as the person's immune system weakens they become increasingly vulnerable to illnesses, many of which they would previously have fought off easily.

The only reliable way to tell whether someone has HIV is for them to take a blood test, which can detect infection from a few weeks after the virus first entered the body.

When HIV causes AIDS

A damaged immune system is not only more vulnerable to HIV, but also to the attacks of other infections. It won't always have the strength to fight off things that wouldn't have bothered it before.

As time goes by, a person who has been infected with HIV is likely to become ill more and more often until, usually several years after infection, they become ill with one of a number of particularly severe illnesses. It is at this point in the stages of HIV infection that they are said to have AIDS - when they first become seriously ill, or when the number of immune system cells left in their body drops below a particular point. Different countries have slightly different ways of defining the point at which a person is said to have AIDS rather than HIV.

AIDS (Acquired Immune Deficiency Syndrome) is an extremely serious condition, and at this stage the body has very little defence against any sort of infection.

How long does HIV take to become AIDS?

Without drug treatment, HIV infection usually progresses to AIDS in an average of ten years. This average, though, is based on a person having a reasonable diet. Someone who is malnourished may well progress to AIDS and death more rapidly.

Antiretroviral medication can prolong the time between HIV infection and the onset of AIDS. Modern combination therapy is highly effective and, theoretically, someone with HIV can live for a long time before it becomes AIDS. These medicines, however, are not widely available in many poor countries around the world, and millions of people who cannot access medication continue to die.

Can You get AIDS

2008-11-02T02:48:00.001-08:00

HIV is a virus that damages human immune cells. It weakens the immune system and leads most people to develop AIDS. Like all viruses, HIV infects the cells of a living organism in order to make copies of itself. HIV can only be transmitted in certain ways and the purpose of this page is to explain how you can and can’t become infected.

For many years now public health campaigns and education programmes have tried to teach people the ways in which they might be at risk of HIV transmission. In spite of this, some people continue to be confused about what is safe and what is not.

This confusion can lead to people becoming unnecessarily worried about ‘catching’ HIV. As a result, they may avoid or reject HIV positive people, increasing prejudice and paranoia about HIV and AIDS, and causing HIV positive people to feel isolated and alone.

Often these fears are unfounded. HIV is a virus that is found in blood and other body fluids such as semen and vaginal fluids. It cannot live for long outside the body, so to be infected with HIV you need to allow some body fluid from an infected person to get inside your body.

The most common ways that people become infected with HIV are:

having sexual intercourse with an infected partner.
injecting drugs using a needle or syringe that has been used by someone who is infected.

HIV can be passed on in both these ways because the virus is present in the blood and sexual fluids of an infected person. If infected blood or sexual fluid gets into your bloodstream, then you can become infected.

You cannot get AIDS from. . .

2008-11-02T02:46:00.000-08:00

Kissing

There is no scientific evidence indicating that any person has ever become infected through kissing an HIV positive person.

To become infected with HIV you must get a sufficient quantity of the virus into the bloodstream. Saliva does contain HIV, but the virus is only present in very small quantities and as such cannot cause HIV infection.

Unless both partners have large open sores in their mouths, or severely bleeding gums, there is no transmission risk from mouth-to-mouth kissing.

Sneezing, coughing, sharing glasses/cups, etc

HIV is unable to reproduce outside its living host, except under strictly controlled laboratory conditions. HIV does not survive well in the open air, and this makes the possibility of this type of environmental transmission remote. In practice no environmental transmission has been recorded.

This means that HIV cannot be transmitted through spitting, sneezing, sharing glasses, cutlery, or musical instruments.

You also can't be infected in swimming pools, showers or by sharing washing facilities or toilet seats.

Insects

Studies conducted by many researchers have shown no evidence of HIV transmission through insect bites, even in areas where there are many cases of AIDS and large populations of insects such as mosquitoes. Lack of such outbreaks, despite considerable efforts to detect them, supports the conclusion that insects do not transmit HIV.

HIV only lives for a short time and cannot reproduce inside an insect. So, even if the virus enters a mosquito or another sucking or biting insect, the insect does not become infected and cannot transmit HIV to the next human it feeds on or bites.

Injecting drugs with sterile needles

Injecting with a sterile needle and works will not transmit HIV as long as clean equipment is used each time and none of it is shared.

However, there are still many other risks associated with injecting drug use. If a person is on drugs (including alcohol) they may cloud judgement and make them more likely to become involved in risky sexual behaviour, increasing the chance of exposure to HIV.

AVERT has more information on the risks involved with recreational drug use and HIV.

Protected sex

If used correctly and consistently condoms are highly effective at preventing HIV transmission. A small minority believe condoms are not adequate protection and that 'some very small viruses can pass through latex'. Scientific tests have proven this theory to be unfounded however.¹

Condoms are effective at preventing HIV during both vaginal and anal sex and can help to reduce the risks during oral sex too.

What is AIDS? What causes AIDS?

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AIDS stands for Acquired Immune Deficiency Syndrome.

An HIV-positive person receives an AIDS diagnosis after developing one of the CDC-defined AIDS indicator illnesses. An HIV-positive person can also receive an AIDS diagnosis on the basis of certain blood tests (CD4 counts) and may not have experienced any serious illnesses. A positive HIV test does not mean that a person has AIDS. A diagnosis of AIDS is made by a physician according to the CDC AIDS Case Definition.

Over time, infection with HIV (Human Immunodeficiency Virus) can weaken the immune system to the point that the system has difficulty fighting off certain infections. These types of infections are known as opportunistic infections. Many of the infections that cause problems or that can be life-threatening for people with AIDS are usually controlled by a healthy immune system. The immune system of a person with AIDS has weakened to the point that medical intervention may be necessary to prevent or treat serious illness.

What is the female condom?

2008-11-02T02:42:00.000-08:00

The female condom is a thin sheath or pouch worn by a woman during sex. It entirely lines the vagina and helps to prevent pregnancy and sexually transmitted diseases (STDs) including HIV. Two types of female condom are available.

The FC / FC2 female condom

The FC female condom has been available in Europe since 1992 and was approved by the US Food and Drug Administration (FDA) in 1993. It is available in many countries, at least in limited quantities, throughout the world. This female condom carries various brand names in different countries including Reality, Femidom, Dominique, Femy, Myfemy, Protectiv’ and Care.

An FC female condom

The FC female condom is a polyurethane sheath or pouch about 17 cm (6.5 inches) in length. At each end there is a flexible ring. At the closed end of the sheath, the flexible ring is inserted into the vagina to hold the female condom in place. At the other open end of the sheath, the ring stays outside the vulva at the entrance to the vagina. This ring acts as a guide during penetration and it also stops the sheath bunching up inside the vagina.

There is silicone-based lubricant on the inside of the condom, but additional lubrication can be used. The condom does not contain spermicide.

In 2005 the makers of the FC female condom announced a new product called FC2. This has the same design as the original version but is made of nitrile, which may make it cheaper to produce. The FC2 began large-scale production in 2007. The United Nations Population Fund (UNFPA) is already procuring the FC2. The United States Agency for International Development (USAID) plans to switch to the new product if it gains FDA approval.

The VA w.o.w. Condom Feminine

A VA w.o.w. Condom Feminine

The VA w.o.w. Condom Feminine (or VA for short) has been distributed as part of HIV prevention efforts in South Africa since 2004. More recently it has become available in Brazil, Indonesia and through government clinics in Portugal. Having gained the “CE mark” for European marketing, its manufacturer plans to expand its availability in European shops and clinics. One more trial is needed before the product can gain FDA approval for sale in the USA.

Like most male condoms, the VA is made of latex. When not stretched it is much shorter than the FC – around 9 cm (3.5 inches) – though it is highly elastic. It has a rounded triangular frame at the open end and a sponge inside the closed end, which helps to anchor it inside the vagina.

The VA is lubricated and does not contain spermicide. Oil-based lubricants should not be used with this female condom as they can damage latex.

How do you use the female condom?

Open the package carefully. Choose a position that is comfortable for insertion - squat, raise one leg, sit or lie down. Make sure the condom is lubricated enough.

If you are using the FC or FC2 female condom, make sure the inner ring is at the closed end of the sheath, and hold the sheath with the open end hanging down. Squeeze the inner ring with thumb and middle finger (so it becomes long and narrow), and then insert the inner ring and sheath into the vaginal opening. Gently insert the inner ring into the vagina and feel it go up. Place the index finger inside the condom and push the inner ring as far as it will go. Make sure the condom is inserted straight, and is not twisted inside the vagina. The outer ring should remain on the outside of the vagina.

To begin inserting the VA, hold the sponge and frame close together and place the closed end in front of the vagina. Use two fingers to push the closed end containing the sponge inside the vagina as far as it will go. Make sure the sponge is opened up flat once it has been inserted. The frame should remain on the outside of the vagina.

The penis should be guided into the condom in order to ensure that the penis does not slip into the vagina outside the condom. Use enough lubricant so that the condom stays in place during sex. The female condom should not be used at the same time as a male condom because the friction between the two condoms may cause the condoms to break.

If the condom slips during intercourse, or if it enters the vagina, then you should stop immediately and take the female condom out. Then insert a new one and add extra lubricant to the opening of the sheath or on the penis.

To remove the condom, twist the outer ring or frame gently and then pull the condom out keeping the sperm inside. Wrap the condom in the package or in tissue and throw it away. Do not put it into the toilet. It is generally recommended that the female condom should not be reused.

The female condom may feel unfamiliar at first. The female condom may feel different and some people find it difficult to insert. Some women find that with time and practice using the female condom becomes easier and easier.

What are the benefits?

Opportunity for women to share the responsibility for the condoms with their partners
A woman may be able to use the female condom if her partner refuses to use the male condom
The female condom will protect against most STDs and pregnancy if used correctly
The FC or FC2 female condom can be inserted up to 8 hours before intercourse so as not to interfere with the moment
The FC and FC2 female condoms are made of polyurethane and nitrile, which are less likely to cause an allergic reaction than latex. These materials can be used with oil-based as well as water-based lubricants. No special storage requirements are needed because polyurethane and nitrile are not affected by changes in temperature and dampness. In addition, these materials are thin and conduct heat well, so sensation is preserved.

What are the disadvantages?

The outer ring or frame is visible outside the vagina, which can make some women feel self-conscious
The FC and FC2 female condoms can make noises during intercourse (adding more lubricant can lessen this problem)
Some women find the female condom hard to insert and to remove
It has a higher failure rate in preventing pregnancy than non-barrier methods such as the pill
It is relatively expensive and relatively limited in availability in some countries
It is recommended that the female condom be used only once

What is the Difference Between HIV and AIDS?

2008-11-02T02:41:00.000-08:00

HIV is the virus that causes AIDS.

H	-	Human: because this virus can only infect human beings.
I	-	Immuno-deficiency: because the effect of the virus is to create a deficiency, a failure to work properly, within the body's immune system.
V	-	Virus: because this organism is a virus, which means one of its characteristics is that it is incapable of reproducing by itself. It reproduces by taking over the machinery of the human cell.

A	-	Acquired: because it's a condition one must acquire or get infected with; not something transmitted through the genes
I	-	Immune: because it affects the body's immune system, the part of the body which usually works to fight off germs such as bacteria and viruses
D	-	Deficiency: because it makes the immune system deficient (makes it not work properly)
S	-	Syndrome: because someone with AIDS may experience a wide range of different diseases and opportunistic infections.

How long does it take for HIV to cause AIDS?

2008-11-02T02:35:00.000-08:00

Currently, the average time between HIV infection and the appearance of signs that could lead to an AIDS diagnosis is 8-11 years. This time varies greatly from person to person and can depend on many factors including a person's health status and behaviors. Today there are medical treatments that can slow down the rate at which HIV weakens the immune system. There are other treatments that can prevent or cure some of the illnesses associated with AIDS. As with other diseases, early detection offers more options for treatment and preventative health care.

What's the connection between HIV and other sexually transmitted diseases?

2008-11-02T02:33:00.000-08:00

Having a sexually transmitted disease (STD) can increase a person's risk of becoming infected with HIV, whether or not that STD causes lesions or breaks in the skin. If the STD infection causes irritation of the skin, breaks or sores may make it easier for HIV to enter the body during sexual contact. Even an STD that causes no breaks or sores can stimulate an immune response in the genital area that can make HIV transmission more likely.

HIV DATA N RELATED INFO.

2008-11-02T02:29:00.000-08:00

Each year since 1998, NACO, the National Institute of Health and Family Welfare and the National Institute of Medical Statistics (a body under ICMR) bring out estimates of India’s population living with HIV and AIDS. Released this year in July, the figures for 2006 represent the most accurate reading yet (see box “Methodology”) of India’s HIV and AIDS numbers. The process of enumeration and the results have been attested to and backed by international agencies – UNAIDS and WHO.

The 2006 estimates suggest national adult HIV prevalence in India is approximately 0.36 percent, amounting to between 2 and 3.1 million people. If an average figure is taken, this comes to 2.5 million people living with HIV and AIDS; almost 50 percent of the previous estimate of 5.2 million.

More men are HIV positive than women. Nationally, the prevalence rate for adult females is 0.29 percent, while for males it is 0.43 percent. This means that for every 100 people living with HIV and AIDS (PLHAs), 61 are men and 39 women. Prevalence is also high in the 15-49 age group (88.7 percent of all infections), indicating that AIDS still threatens the cream of society, those in the prime of their working life.

While adult HIV prevalence among the general population is 0.36 percent, high-risk groups, inevitably, show higher numbers. Among Injecting Drug Users (IDUs), it is as high as 8.71 percent, while it is 5.69 percent and 5.38 percent among Men who have Sex with Men (MSM) and Female Sex Workers (FSWs), respectively. To read more...

REPRODUCTIVE SYSTEM IN MALES AND FEMALES

2008-11-02T02:26:00.000-08:00

What is the reproductive system in females like?

The reproductive system in females consists of outer (external genitals) and inner structures. The outer structures include vulva and vagina. The inner structures consist of the uterus, ovaries and cervix.

What are the salient features of the outer structures?

The outer structures include the vulva and vagina. The vulva is the external visible portion while the vagina is a muscular tube that connects the uterus and cervix to the outside of the body. The vagina allows for the flow of menstrual blood and for sexual intercourse, and is the passageway through which a baby is born.

What are the salient features of the inner structures?

The inner structures consist of the uterus, ovaries and cervix. The uterus commonly referred to as the womb, is a hollow muscular organ located in the lower abdomen. The main function of the uterus is to nourish the developing baby prior to birth. The cervix is the lower end of the uterus. It is located at the top of the vagina and is about one inch long. The cervix allows for flow of menstrual blood and passage of the baby from the uterus during delivery. It also provides a passage way for the sperms to move up from the vagina towards the ovaries. The ovaries are organs which produce the ovum or egg and are located at the tubal ends (also known as fallopian tubes) of the uterus.

What is the reproductive system in males like?

The reproductive system in males consists of outer visible structures which include the penis and scrotum and inner structures which include testes, vas deferens, prostrate, epididymis and seminal vesicles.

What are the salient features of the outer structures?

The penis is the male organ used for urination and sexual intercourse. It is made of spongy tissue and blood vessels. The scrotum consists of a pair of outer sacs located on both sides of the penis which contain the testes.

What are the salient features of the inner structures?

The inner structures include testes, vas deferens, epididymis and seminal vesicles. The testes are two egg-shaped male reproductive organs located in scrotum. They produce sperm and the male hormone, testosterone. The sperms are stored in the epididymis till they attain complete maturation. The vas deferens is tubes which carry the sperm to the seminal vesicles, where the sperms are stored before being released into the opening of the penis for ejaculation. The prostrate is a sex gland in men. It is about the size of a walnut, and surrounds the neck of the bladder and urethra - the tube that carries urine from the bladder. The prostate gland secretes a slightly alkaline fluid that forms part of the seminal fluid, a fluid that carries sperm.

PUBERTY N RELATED INFO.

2008-11-02T02:22:00.000-08:00

What is puberty?

Puberty is the time in which sexual and physical characteristics mature. It occurs due to hormone changes. The changes allow you to become capable of reproduction.

What is the timing of Puberty?

Puberty starts at different times and lasts for different periods of time for everyone. It can start as early as 9 years of age to as late as 13 –14 years of age. The sequence of pubertal development usually ranges from 2 to 5 years. Some adolescents might have completed puberty before their peers have even begun.

What are the signs of puberty in boys?

At puberty, boys will normally experience a faster growth, especially in height. The shoulder width also increases. The body takes on a new more muscular and angular shape in boys under the influence of testosterone. There is growth of the penis and the skin of the scrotum becomes reddened and folded. The voice deepens, and while the process is gradual, one might experience voice breaking at times. This is normal and natural and does not call for worry. There is appearance and growth of pubic, beard, and armpit hair. Nighttime ejaculations (nocturnal emissions or "wet dreams") are common. The skin becomes oily resulting in acne.

What are the signs of puberty in girls?

There is an increase in height and hip size. Hair growth appears in the genital area, in the armpits and around the breast. At first the hair are soft but with further growth become coarser. A girl starts with her menstrual periods, which is a monthly bleeding from the vagina lasting for 5 days which results due to hormonal influences on the reproductive system. The skin becomes oily resulting in acne.

What breast changes occur during puberty?

The breasts develop and enlarge due to the accumulation of fat which occurs under the influence of the hormone estrogen.

What changes occur in the female reproductive organs as a result of puberty?

As a female’s body begins the process of puberty, special hormones are released that create changes to the internal reproductive organs inside of a girl's body. The vagina becomes deeper, and girls may notice some wetness, called vaginal discharge, on their panties. The color of the discharge is usually clear to whitish and, it's normal in small amounts, so it's nothing to worry about. The uterus becomes longer and the lining of the uterus becomes thicker. The ovaries enlarge and the egg cells inside the ovaries begin to grow and develop getting ready for a special monthly event called ovulation.

What is ovulation?

Ovulation is the release of an egg cell from one of the ovaries. This event occurs approximately once a month near the midpoint of a women's menstrual cycle. Upon release, the egg travels into the fallopian tube and then begins a four to five day journey to the uterus. The fallopian tube is only about five inches long and very narrow, so this is a slow journey. The egg cell moves about one inch per day.

What is fertilization?

Fertilization is when a sperm cell from the father meets and joins with an egg cell from the mother as a result of sexual intercourse. Fertilization occurs when the egg cell is inside of the fallopian tube. The egg and sperm need to meet and combine in order to make a baby. When they do, a woman becomes pregnant.

What is menstruation?

The ovaries of a girl between the ages 10-15 years start producing a mature egg or ovum each month. The egg travels down a tube (Fallopian tube), which connects the ovary to the womb. When the egg reaches the womb, the lining becomes thick with blood and fluid. This happens so that if the egg is fertilized, it can grow and develop in the lining to produce a baby. If the egg does not meet with sperm from a male and is not fertilized, it dissolves. The thickened lining sloughs off and forms menstrual blood flow, which passes out of the body through the vagina.

What is the normal frequency of menstrual cycles?

Menstrual cycles once every month, at a frequency of every 28 to 32 days.

What is the normal duration of a menstrual period?

While most menstrual periods last from three to five days, anywhere from two to seven days is considered normal.

How can hygiene be maintained during periods?

Once you begin menstruating, you'll need to use a sanitary napkin or pad something to soak up the menstrual blood. Pads are made of layers of cotton. Some have extra material on the sides (called "wings") that fold over the edges of your underwear to better hold the pad in place and prevent leakage.

What are the types of sanitary pads?

Pads come in several different thicknesses for heavier or lighter menstrual periods or for day or nighttime use. Some pads come with a deodorant or deodorizing substance in them. All pads have a sticky strip on the bottom that helps them to adhere to your underwear.

How should a pad be used?

Pads are easy to use: You peel off the strip that covers the adhesive, press the pad into the crotch of your underwear (wrapping the wings around and sticking them under the crotch if the pad you're using has wings).

How frequently should a pad be changed?

It's best to change pads every 3 or 4 hours, even when you're not menstruating very much. because regular changing prevents buildup of bacteria and eliminates odour. Naturally, if your period is heavy, you should change pads more often because they may get saturated more quickly.

How should a pad be disposed?

Once you've removed your pad, wrap it tightly in a polythene and put it in the garbage can. Don't try to flush a pad down the toilet - they're too big and may block the sewer drain.

What is acne? Why does it occur?

Acne is a skin condition characterized by whiteheads, blackheads, and inflamed red pimples. Acne occurs when tiny holes on the surface of the skin called pores become clogged. Normally, the oil glands help keep the skin lubricated and help remove old skin cells. During adolescence the glands produce too much oil; the pores become blocked, accumulating dirt, debris, and bacteria resulting in production of blackheads and pimples.

How can the effects of acne be lessened?

Take the following self-care steps to lessen the effects of acne: (i) Clean your skin gently with a mild, non-drying soap.(ii) Remove all dirt or make-up. Wash once or twice a day with fresh water, including after exercising. However, avoid excessive or repeated skin washing. (iii) Shampoo your hair daily, especially if it's oily. Comb or pull your hair back to keep the hair out of your face. Avoid tight headbands. (iv) Try not to squeeze, scratch, pick, or rub the pimples. Although it might be tempting to do this, it can lead to scarring and skin infections. (v) Avoid touching your face with your hands or fingers. (vi) Avoid greasy cosmetics or creams (vii) If the pimples are still a problem, a doctor can prescribe stronger medications and discuss other options with you.

REPRODUCTIVE HEALTH CONCERNS IN FEMALES

2008-11-02T02:21:00.002-08:00

A. MENSTRUAL PROBLEMS

What is a painful menstrual period?

Painful menstrual periods are marked by crampy lower abdominal pain. A woman may feel sharp pain that comes and goes, or have dull, aching pain. Painful menstrual periods may also cause back pain. The pain may begin several days before or just at the start of your period. It generally subsides as menstrual bleeding tapers off.

How can painful menstrual periods be managed at home?

The following steps may allow you to avoid prescription medications: (i) Apply a heating pad to your lower abdomen (below the umbilicus). Be careful NOT to fall asleep with it on. (ii) Take warm showers or baths. (iii) Drink warm beverages. (iv) Do light circular massage with your fingertips around your lower abdomen. (v) Walk or exercise regularly, including pelvic rocking exercises. (vi) Follow a diet rich in complex carbohydrates such as whole grains, fruits, and vegetables, but low in salt, sugar, alcohol, and caffeine. (vii) Eat light but frequent meals. (viii) Practice relaxation techniques like meditation or yoga. (ix) Keep your legs elevated while lying down. Or lie on your side with knees bent.

When should a doctor be consulted for painful menstrual periods?

A doctor may be consulted if self care measures have not relieved the pain for 3 consecutive months or if there is a history of passage of large blood clots. Also occurrence of pain more than 5 days prior to the period and continuation after the period gets over warrants a doctor’s consultation.

What is pre-menstrual syndrome?

Premenstrual syndrome (PMS) involves symptoms that occur in relation to the menstrual cycle. The symptoms usually begin 5 to 11 days before the start of menstruation. Symptoms usually stop when menstruation begins, or shortly thereafter. These symptoms may include headache, swelling of the feet, backache, abdominal cramps, breast tenderness, bloating sensation etc.

What are the causes of PMS?

An exact cause of PMS has not been identified. It occurs more often in women between their late 20s and early 40s, those with at least one child, those with a family history of depression, or women with a past medical history of depression after delivery of first child.

How can pre menstrual syndrome be managed at home?

Self-care methods for managing PMS include: (i) Regular Exercise – at least twenty minutes to half an hour everyday, which may include brisk walking or cycling.(ii) Dietary measures: Increased whole grains, vegetables, fruit, and decreased or no salt, sugar and coffee may prove beneficial. (iii) Maintain a daily diary or log to record the type, severity, and duration of symptoms. A "symptom diary" should be kept for a minimum of 3 months. The diary will greatly assist the doctor not only in the accurate diagnosis of PMS, but also with the proposed treatment methods. (iv) It is important to get adequate rest.

When is a heavy menstrual period said to be occurring?

If there is soakage through a sanitary pad every hour for 6 consecutive hours, this is considered a very heavy period.

What are the common causes of heavy menstrual periods?

The common causes of heavy menstrual periods include: (i)Growths on the uterine lining (ii) Unexplained- referred to as dysfunctional uterine bleeding (iii) Thyroid gland problems (iii) Blood clotting disorders. (iv)Intra uterine device. (v) Stress.

What is a prolonged menstrual period?

A prolonged period is one that lasts longer than 7 days.

What are the common causes of prolonged menstrual periods?

Prolonged menstrual periods may result from (i) Ovarian cysts (ii) Sometimes the cause may not be found-referred to as dysfunctional uterine bleeding. (iii)Bleeding disorders and intake of anti clotting medications. (iv) Stress

What is an irregular menstrual period?

An irregular menstrual period is one in which the duration can vary excessively from cycle to cycle, with the periods occurring too frequently or being separated by an unusually long duration.

Is it normal to have irregular periods during the first few teenage years?

Yes. At first, the menstrual periods typically are irregular. The girl may have 2 months between periods, or may have two periods in 1 month. Over time, they become more regular.

What are the causes of irregular menses?

Menstrual periods that are abnormally frequent can be caused by (i) Endometriosis is a condition of unknown cause that can lead to pelvic pain and frequent bleeding. (iii) Sometimes, the cause of unclear, in which case the woman is said to have dysfunctional uterine bleeding. (iii)Ovarian cysts (iv) Stress

Is there a cause for worry if bleeding during menses lasts for only 2-4 days instead of the usual 5 days?

No, there is no need to worry. Periods change over time and from cycle to cycle.

What needs to be done in case of Heavy, Prolonged or Irregular Menstrual Periods?

(i) Keep a record of your menstrual cycles, including when menstruation begins and ends, how much flow you have (count numbers of pads used, noting whether they are soaked), and any other symptoms you experience. (ii) Consult a doctor if the problem persists beyond 3 months.

What is absent menstruation?

Absent menstruation refers to appearance of no menstruation by age 16. The Causes may include: (i) Birth defects of the female reproductive system (ii) Lack of an opening in the membrane at the entrance of the vagina (hymen) (iii) Problem with glands in the brain

B. ABNORMAL VAGINAL DISCHARGE

What is vaginal discharge and when is it said to be abnormal?

Vaginal discharge is composed of mucous secretion produced by the cervix. Disease may be indicated if vaginal discharge is abnormal in color, odour, or consistency, or significantly increased in amount.

Which are the conditions that lead to an increase in the normal vaginal secretion?

The amount of normal vaginal discharge may be increased in conditions such as sexual excitement, emotional stress and ovulation (when you produce and release an egg from your ovary in the middle of your menstrual cycle)

What are the causes of abnormal vaginal discharge?

These conditions can lead to abnormal vaginal discharge: (i) Sexually transmitted infections. (ii) Fungal/yeast infection of the vagina common in diabetics and those with weak immune system.

How can abnormal vaginal discharge be prevented?

To help prevent vaginal discharge: (i) Genital area must be kept clean and dry. (ii) Douching (splashing water into the genital area) should be avoided. While many women feel cleaner if they douche after menstruation or intercourse, it may actually worsen vaginal discharge because it removes healthy bacteria lining the vagina that are there to protect you from infection. (iii) Stress should be avoided. (iv) Condoms must be used to avoid catching or spreading sexually transmitted diseases. (v) Blood sugars should be kept under good control in case there is presence of diabetes.

Should a doctor be consulted for an abnormal vaginal discharge?

Yes, a doctor should be consulted promptly. Your doctor will take a brief history about your symptoms, conduct a pelvic examination and prescribe a treatment accordingly.

C. OVARIAN CYSTS

What are ovarian cysts?

An ovarian cyst is a growth or swelling on, or inside, the ovary. It may be solid, or filled with fluid.

Are ovarian cysts cancerous?

The vast majority of ovarian growths are not cancerous.

What are the symptoms of ovarian cysts?

Ovarian cysts may produce the following symptoms: (i) Many women experience no symptoms when they have an ovarian cyst, particularly if it's small. (ii) Certain cysts grow large and may cause the abdomen to swell. (iii) Depending on where the cyst is and its size, it may put pressure on the bladder or bowels, making you need to go to the toilet more often. (iv) You may also notice abdominal discomfort and sex may be uncomfortable or painful. (v) Your periods may be affected; they may become irregular or the bleeding may be heavier or lighter than usual. (vi) Appearance of excess facial and body hair (vii) Deepening of voice.

What is the treatment for ovarian cysts?

While some cysts may disappear on their own, other cysts may need surgery. Your doctor will discuss with you the pros and cons of surgery.

What is Polycystic Ovary Syndrome (PCOS)?

Polycystic simply means 'many cysts' and describes the appearance of the ovary on ultrasound scan.

What are the symptoms of PCOS?

The symptoms of PCOS include: (i) Irregular or absent periods (ii) Infertility (iii) Unwanted body hair (iv) Acne (v) Weight gain (vi) Abdominal discomfort.

What is the treatment for PCOS?

PCOS can be treated by hormonal medicines or surgery. The discretion for treatment lies with the doctor.

D.PROLAPSE

What is prolapse?

Prolapse refers to descent of a pelvic organ like uterus, bladder, urethra or rectum into the vagina.

What are the causes of prolapse?

Prolapse occurs as a result of weakening of the pelvic muscles due to (i) repeated childbirth (ii) old age (iii) lumps in the uterus due to fibroid (iv) obesity (v) Spinal injuries.

What are the common symptoms of prolapse?

Symptoms that may be occur with all types of prolapse: (i) Feeling a lump or heavy sensation in the vagina (ii) Lower back pain that eases when you lie down (iii) lower abdominal pain or pressure (iv) Pain or lack of sensation during sex (v) inability to control urination and leaking urine.

What treatment options are available for prolapse?

Mild degrees of prolapse can be treated by (i) Pelvic exercises (ii) Inserting vaginal pessary to hold the prolapsed organ in place. Severe degrees of prolapse need to be corrected by different kinds of surgery.

E. VULVAL PAIN AND DISCOMFORT

What can cause vulval pain and itching?

Pain, itching, burning and irritation of the vulval area can be the result of a vaginal infection , or the result of a non-infectious skin problem such as dermatitis, eczema.

What are the causes of non infectious skin diseases which can cause vulval pain and discomfort?

A woman's vulva can also be affected by skin problems that are not infectious and cannot be passed on to sexual partners. Soap, disinfectants and detergents used for washing underwear can easily irritate vulval skin.

How can vulva skin problems be treated?

Treatment often includes using a steroid cream and emollients which are bland creams and ointments free of skin irritants. They can be used to soothe and hydrate sore and cracked skin and as a soap substitute to clean the vulva. They are available as creams and lotions and are available from chemists without a prescription.

How can a woman care for her vulval skin?

If you have, or are prone to, vulval problems, avoid wearing tights or tight fitting trousers. Avoid synthetic underwear and try cotton underwears that are not too tight. Use mild soap for washing the vulval skin.

What is the commonest cause of swelling in the vulva?

The commonest cause for swelling in the vulva is known as “Bartholin’s cysts”. Bartholins glands are two tiny glands present on both sides of the vaginal opening. There are tiny ducts in the gland and if those get 'clogged' up by skin cells or secretions, it can form a cyst - (a fluid filled sac). The cyst can grow from the size of a pea to larger than a golf ball.

How is Bartholin’s cyst treated?

The treatment really depends on several things; the size of the cyst, how painful it is, if it is infected and how your gynecologist chooses to treat them. Some cysts are just treated with oral antibiotics. Sometimes your gynecologist might decide to put a 'drain' into the cyst, The drain (like a thick string) stays in place for about 2 to 4 weeks. This allows the fluid to drain and causes a small opening to form inside the lip of your vagina. The drain is removed after that 2 - 4 week period.

F. OBSTETRIC FISTULA

What is an obstetric fistula?

A fistula is a hole between a woman's birth passage and one or more of her internal organs. This hole develops over many days of obstructed labor, when the pressure of the baby's head against the mother's pelvis cuts off blood supply to delicate tissues in the region. The dead tissue falls away and the woman is left with a hole between her vagina and her bladder and sometimes between her vagina and rectum. This hole results in permanent leaking of urine and/or feces.

What are the causes of obstetric fistula?

A fistula results from an obstructed labor that is left unrelieved and untreated. There are three delays that contribute to the development of a fistula: delay in seeking medical attention during labour; delay in reaching a medical facility; and delay in receiving medical care once arriving at a health care facility.

Can a fistula be cured?

Yes. An obstetric fistula can be closed with intravaginal surgery. If her surgery is performed by a skilled surgeon, a fistula patient has a good chance of returning to a normal life with full control of her bodily functions. The operation has a 93% success/cure rate.

G. ECTOPIC PREGNANCY

What is ectopic pregnancy?

Ectopic pregnancy is one in which the fertilized ovum (egg) is implanted and develops outside the uterus. The most common site is tube. Normally fertilization occurs in the tube and the fertilized ovum moves into the uterus. But in tubal pregnancy the ovum remains in the tube.

What are the main symptoms of an ectopic pregnancy?

The four important symptoms are-

Ammenorrhoea (no periods) of short duration.

Severe abdominal pain.

Vaginal bleeding.

Nausea, vomiting and fainting attacks.

What is to be done on suspicion of an ectopic pregnancy?

A. The women should be urgently rushed to a hospital. The principle in the management of acute ectopic is resuscitation and surgery done at the same time. Blood transfusion is done if required. A quick surgery stops the bleeding and improves the patients condition.

I. CANCERS OF THE REPRODUCTIVE TRACT

What is cancer?

Cancer affects body's basic unit, the cell. Cancer occurs when cells become abnormal and divide without control. This mass of extra tissue, called a growth or tumor, can be benign or malignant.

What is a benign tumour?

Benign tumors are not cancerous. They can usually be removed and, in most cases, they do not come back. The most important thing is that cells from benign tumors do not spread to other parts of the body.

What is a malignant tumour?

Malignant tumors are cancer. Cancer cells can invade and damage tissues and organs near the tumor. Cancer cells also can break away from a malignant tumor and enter the bloodstream and spread throughout the body.

I 1 CERVICAL CANCER

Who are the women who are at risk of getting cervical cancer?

Women who are at risk of getting cervical cancer are those who (i) have Multiple sexual partners (ii) started sexual intercourse early in life –during teens or early twenties (iii) women with history of genital warts or chronic sexually transmitted infections.

What are symptoms of cervical cancer?

In the initial stages, cervical cancer does not produce symptoms, Symptoms are produced when the cancer cells start invading nearby tissues. The most common symptom is abnormal bleeding. Bleeding may start and stop between regular menstrual periods, or it may occur after sexual intercourse. Menstrual bleeding may last longer and be heavier than usual. Increased vaginal discharge is another symptom of cervical cancer. These symptoms may be caused by cancer or by other health problems. Only a doctor can tell for sure. It is important for a woman to see her doctor if she is having any of these symptoms.

Can cervical cancer be prevented?

Yes, cervical cancer can be prevented by early detection of changes in the cervix by means of getting a regular cervical smear or Pap smear test done.

What is a Cervical smear or Pap smear test?

A smear test is a simple examination to check the health of a woman’s cervix. It is called a smear test (or Pap smear) because the doctor or nurse takes a small sample of cervical cells and smears them onto a glass slide to be analysed under a microscope.

Who should have a smear test?

All sexually active women should get a cervical smear test done every 3 to 5 years.

Is there any need for a non sexually active woman to get her smear test done?

Cervical cancer is extremely rare in women who have never been sexually active, therefore most recommendations suggest women don’t need to have smears until they’ve had sex.

How is a Pap smear done?

A warmed speculum is passed into the vagina to separate the walls so the doctor can see your cervix. A wooden spatula (thinner than a tongue depressor) is wiped across the cervix, and the smear is transferred to a glass slide.

When is the best time to get a smear done?

The best time to get a smear done is between the middle of your menstrual cycle – about half way between one period and the next. It’s easiest to get a good cell sample from your cervix at this time.

Is any vaccine available for protection against cervical cancer?

Yes, a vaccine (HPV Vaccine) is now available which protects against a virus known as Human Papilloma virus which is responsible for causing 70 % of cervical cancers

Who should receive the HPV vaccine?

The vaccine is for girls and women ages 9 to 26. It works when given before one has any contact with virus.

How is HPV Vaccine administered?

The vaccine is administered as 3 injections given over a span of 3 months.

What are its side effects?

It can cause pain, swelling, itching, and redness at the injection site, fever, nausea, and dizziness.

Does the vaccine protect everyone who is vaccinated against cervical cancer?

The vaccine may not fully protect everyone and does not prevent all types of cervical cancer, so it is important to continue regular cervical cancer screenings.

I 2 OVARIAN CANCER

Who are the women who are at risk of getting ovarian cancer?

The exact causes of ovarian cancer are not known. However, studies show that the following factors may increase the chance of developing this disease : (i) Family history. First-degree relatives (mother, daughter, sister) of a woman who has had ovarian cancer are at increased risk of developing this type of cancer themselves (ii) Age. The likelihood of developing ovarian cancer increases as a woman gets older. Most ovarian cancers occur in women over the age of 50, with the highest risk in women over 60. (iii) Women who have never had children are more likely to develop ovarian cancer

What are the symptoms of ovarian cancer?

The symptoms of ovarian cancer are almost similar to those of benign ovarian conditions such as menstrual disturbances, abdominal discomfort. At times, the symptoms may be vague such as loose motions, weight loss etc. Thus, you should see your doctor promptly

What are the treatment options for ovarian cancer?

Treatment options and outcomes for patients who have ovarian cancer depend on the exact classification of the cancer and how far it has spread before it is diagnosed

Is there any screening test for preventing ovarian cancer?

No screening test has yet been developed for early diagnosis of ovarian cancer.

SEXUALLY TRANSMITTED INFECTIONS INCLUDING HIV/AIDS

2008-11-02T02:21:00.001-08:00

A. SEXUALLY TRANSMITTED INFECTIONS

What is a sexually transmitted disease?

The general term sexually transmitted disease (STD) is applied to any of the group of diseases that can be spread by sexual contact.

How do sexually transmitted diseases spread?

STDs are spread from one person to another through intimate sexual contact such as sexual intercourse, oral sex and anal sex.

What are the symptoms of STDs?

The symptoms of STIs may include the following- (i)Itching around the vagina and/or discharge from the vagina in women (ii)Discharge from the penis in men (iii) Pain during sex or when urinating (iv)Painless red sores on the genital area. (iv) Soft flesh coloured warts around genital area (v)Pain in or around the anus for people who have anal sex (vi) Unusual infections, unexplained fatigue, night sweats and weight loss

Is it possible for a person to have STD and not to know about it?

Symptoms of STD in men are often visible, hence they become aware that their sexual organs have been infected. However, women with STIs can be asymptomatic which means that signs of infection are not apparent even though infection is present.

Can STDs cause other health problems?

Yes. While each STD causes different health problems, overall, they can cause cervical cancer and other cancers, liver disease, infertility, pregnancy problems, and other complications. Some STDs increase your risk of getting HIV/AIDS.

What is to be done in case of suspicion of an STD?

If you suspect that you have an STD, don't be shy or afraid to seek help. See your doctor and ask for an STD check up or go consult a skin specialist if you are a male or gynecologist if you are a female. Don't ignore symptoms or wait for them to go away. STDs are common and highly contagious and are more easily treated if caught early.

What are the ways to prevent STD s?

One may protect oneself against STDs by (i) Staying in a monogamous relationship and ensuring that her/his partner is also in a monogamous relationship (ii) Male latex condoms can reduce your risk of getting an STI if used correctly. Be sure to use them every time you have sex. Female condoms aren't as effective as male condoms, but should be used when a man won't use a male condom.

B.HIV/AIDS

What is HIV and AIDS?

AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is caused by the HIV (Human Immunodeficiency Virus) which attacks the body's immune system - your defense against infections. Without this protection, people with AIDS suffer from fatal infections and cancers.

How is it spread?

HIV is spread from an infected person to someone else when there is an exchange of semen, vaginal fluids or blood. This occurs during (i) sexual intercourse, (ii) through the sharing of needles for injection or (iii) from an infected pregnant mother to her child, at or about the time of birth.

Can HIV be contracted through oral sex?

Although it is possible to become infected with HIV through oral sex, the risk of becoming infected in this way is much lower than the risk of infection via unprotected sexual intercourse with a man or woman.

Is unprotected anal intercourse more of an HIV risk than vaginal or oral sex?

Unprotected anal intercourse does carry a higher risk than most other forms of sexual activity. The lining of the rectum has fewer cells than that of the vagina, and therefore can be damaged and cause bleeding during intercourse. This can then be a route into the bloodstream for infected sexual fluids or blood.

How is HIV not spread?

HIV is not passed on by everyday social contact such as (i) sharing toilets,
(ii) sharing utensils (iii) social gestures like shaking hands, embracing etc. (iv) Pets and biting insects, such as mosquitoes (v) Coughing/ sneezing

Is there a risk of HIV transmission when having a tattoo, body piercing or visiting the barbers?

If instruments contaminated with blood are not sterilised between clients then there is a risk of HIV transmission.This can be avoided by using disposable blades.

Can HIV be transmitted by kissing?

Saliva does not transmit HIV although the virus has been found in the saliva of HIV infected people. If both partners have cuts or sores in the mouth or bleeding gums, infected blood could possibly be exchanged- hence deep kissing should be avoided.

How can I tell if I have an HIV infection?

There is a simple blood test that will tell you if you are infected with HIV. It's called the HIV antibody test. Your body reacts to the presence of the virus by producing antibodies. A test that discovers these antibodies indicates that you are infected.

What is “window period” in HIV testing?

HIV antibodies can take up to 14 weeks or longer to appear in the blood . During this period, known as the “window period” you can test negative but actually have the virus.

What is the difference between HIV and AIDS?

AIDS is the most advanced stage of HIV infection.

What are the symptoms which manifest immediately following infection?

Many people do not develop HIV AIDS symptoms after getting infected with HIV AIDS . Some people have HIV AIDS symptoms like a flu-like illness within several days to weeks after exposure to the virus. They complain of fever, headache, tiredness, and enlarged glands in the neck. These HIV AIDS symptoms usually disappear on their own within a few weeks.

How long does it take for the disease to progress?

The progression of disease varies widely among individuals. This state may last from a few months to more than 10 years. During this period, the virus continues to multiply actively and infects and kills the cells of the immune system by destroying primary infection fighters, called CD4+ or T4 cells.

What are the symptoms of HIV/AIDS?

Once the immune system weakens, a person infected with HIV /AIDS can develop the following symptoms: (i) Lack of energy (ii)Weight loss (iii) Frequent fevers and sweats (iv) Persistent or frequent fungal infections (v) persistent diarrhoea (vi)Short-term memory loss (vii) Mouth, genital, or anal sores (viii) Cough and shortness of breath

I think I may be infected with HIV or AIDS. What should I do?

See a doctor if you think you may be at risk or if you have symptoms. You may need to have a blood test. A positive result means that you have been exposed to the virus and could pass it on to others.

How is it treated?

There is no cure for HIV infection or AIDS; the virus remains in the body for life. Several drugs are being tried. One of these, AZT, arrests the progress of the HIV infection but is not a cure. There are other drugs to treat the infections and cancers which could develop.

CONTRACEPTION N REALTED INFO.

2008-11-02T01:55:00.000-07:00

A.GENERAL

What are the contraceptive choices available for males?

The contraceptive choices available for males include: condoms for temporary protection and vasectomy for permanent protection.

What are the contraceptive choices available for females?

The contraceptive choices available for females include: (i) Female condom (ii) Spermicides (iii) Oral pills (iv) Injectable contraceptives (v) Intra uterine device (vi) Tubectomy.

What is the range of contraceptives available depending upon the need?

The range of contraceptives depending upon the need may be presented as follows:

SITUATION	CONTRACEPTIVE CHOICE
Teens/ Young married couples- having no children	Condom: Male/ Female Combined hormonal contraceptive pills Progestin only pills Centchroman (Saheli) Depo- Provera Norplant
Married Couples having children but willing for more; desirous of spacing pregnancy	Condom: Male/ Female Combined hormonal contraceptive pills Progestin only pills IUD Depo- Provera Norplant
Married couples who have completed their family	Progestin only pills Depo- Provera Norplant IUD Sterlization- male/female
Breastfeeding mothers	Condom: Male/ Female Progestin only pills Depo- Provera Norplant IUD

B.MALE CONDOM

What is a male condom?

A male condom is a sheath made to fit over a man’s erect penis.

What material is a condom made of?

Most condoms are made of latex rubber.

What are the advantages in using a condom?

Using a condom may have the following advantages: ( I) Condoms are one of the most reliable methods of birth control when use properly and consistently.(ii) Condoms are user friendly. With a little practice, they can also add confidence to the enjoyment of sex. (iii) Condoms are only needed when you are having sex unlike some other contraceptives which require you to take or have them all of the time.(iv) Condoms are the only contraceptive that also helps prevent the spread of sexually transmitted diseases (STDs) including HIV when used properly and consistently. (v) Can be used by men of any age. (vi)Usually easy to obtain and sold at most places.

What are the disadvantages of using a condom?

The disadvantages of using a condom are as follows: (i) May cause itching for a few people who are allergic to latex.(ii)There is a small possibility that the condom might slip off or break during sexual intercourse. (iii) If used with oil based lubricants such as vaseline or oil, condoms can go weak and break.

What is the effectiveness of a condom in protection against pregnancy?

If the partners of 100 women start using condoms, coreectly and consistently, there are 3 pregnancies per 100 women in the first year of use. With irregular or inconsistent use, there is a likelihood of 14 of these women getting pregnant in the first year of use of condoms.

What could be the possible reasons for incorrect or improper usage?

Improper or incorrect usage may result due to reasons such as- wearing the condom before complete erction, not wearing the condom upto the shaft etc.

What is the technique of correct usage of a condom?

The technique of correct usage of a condom is as follows: (i) Make sure the package and condom appear to be in good condition, and check that if there is an expiry date that the date has not passed. (ii) Open the condom package at one corner being careful not to tear the condom with your fingernails, your teeth, or by being too rough. (iii) Place the rolled condom over the tip of the hard penis. (iv) Roll the condom all the way down to the base of the penis, and smooth out any air bubbles. (Air bubbles can cause a condom to break).(v) Leave a space of atleast half an inch at the tip of the condom for the semen to accumulate.(vi) If you want to use some extra lubrication, put it on the outside of the condom. But always use a water-based lubricant (such as KY Jelly - available at all leading chemist shops). Do not use an an oil-based lubricant such as vaseline /baby oil/coconut oil since will cause the latex to break.

What is to be done if the condom does not unroll?

The condom should unroll smoothly and easily from the rim on the outside. If you have to struggle or if it takes more than a few seconds, it probably means that you are trying to put the condom on upside down. To take off the condom, don't try to roll it back up. Hold it near the rim and slide it off. Then start again with a new condom.

When should the condom be removed ?

Pull out before the penis softens, and hold the condom against the base of the penis while you pull out, so that the semen doesn't spill.

How should a condom be disposed?

Condom should be disposed properly for example wrapping it in a paper or tissue and throwing it away. It's not good to flush condoms down the toilet – as they are non biodegradable and can block the sewer drain.

What should be done if the condom breaks during intercourse?

If a condom breaks during sexual intercourse, then pull out quickly and replace the condom. Whilst you are having sex, check the condom from time to time, to make sure it hasn't split or slipped off. If the condom has broken and you feel that semen has come out of the condom during sex, you should consider getting emergency contraception such as the morning after pill.

Are two condoms more effective than one?

Don't use two condoms at once, the latex rubbing against each other may cause the latex to tear.

Please give some tips for caring for condoms.

1.Condoms should be stored in a cool dark place if possible.

2.Avoid exposure of the condom to excessive heat, light and humidity.

3.Handle condoms carefully. Fingernails and rings can damage condoms.

4.Do not unroll condom befor use, this may weaken them.also an unrolled condom is difficult to put on.

What is to be done if a condom or lubricant causes itching or rash on genitals.

If condom or lubricant causes itching or rash on genitals, the following may be done: (i) Try using water as a lubricant. (ii) Consult a doctor to rule out itching or allergy.

What is to be done if a man cannot maintain an erection while putting on or using a condom?

In such a case, the following may be done: (i) Try using a dry condom without spermicide. (ii) Female partner can be asked to try putting on the condom for the man, which would help to make its use more enjoyable. (iii) An extra amount of water or water based lubricant such as KY jelly may be used on the penis and extra lubricant on the outside.

C. FEMALE CONDOM

What is a female condom?

The female condom is a polyurethane sheath or pouch about 17 cm (6.5 inches) in length. It is worn by a woman during sex. It entirely lines the vagina and it helps to prevent pregnancy and sexually transmitted diseases (STDs) including HIV.

What are the features of the female condom?

At each end of the condom there is a flexible ring. At the closed end of the sheath, the flexible ring is inserted into the vagina to hold the female condom in place. At the other open end of the sheath, the ring stays outside the vulva at the entrance to the vagina. This ring acts as a guide during penetration and it also stops the sheath bunching up inside the vagina. The condom is already smeared with a silicone based lubricant on its inner side.

What are the benefits of using a female condom?

The benefits of using a female condom are: (i) Opportunity for women to share the responsibility for the condoms with their partners (ii) A woman can use the female condom if her partner refuses to use the male condom (iii)The polyurethane, the material the female condom is made of, is less likely to cause an allergic reaction than a male latex condom. (iv)The female condom will protect against most STDs and pregnancy if used correctly .(v)It can be inserted up to 8 hours before intercourse so it does not interfere with the moment (vi)The polyurethane is thin and conducts heat well so sensation is preserved (vii)The female condom can be used with oil-based lubricants (v) No special storage requirements are needed because polyurethane is not affected by changes in temperature and dampness. The expiry date for female condoms is 5 years from the date of manufacture.

What is the effectiveness of the female condom in preventing pregnancy ?

When used correctly and consistently, effectiveness of the female condom is up to the extent of 98 %. If not used correctly or consistently, the effectivenss rate drops.

What is the correct technique in using female condom?

The correct technique in using a female condom is as follows: (i) Open the package carefully. Choose a position that is comfortable for insertion - squat, raise one leg, sit or lie down. (ii) Squeeze the inner ring with thumb and middle finger (so it becomes long and narrow), and then insert the inner ring and sheath into the vaginal opening.(iii) Place the index finger inside of the condom and push the inner ring as far as it will go. (iv) Make sure the condom is inserted straight, and is not twisted inside the vagina. The outer ring should remain on the outside of the vagina.(v) The penis should be guided into the condom in order to ensure that the penis does not slip into the vagina outside the condom.

How easy to use are female condoms?

Female condoms are not difficult to use, but you may want to practice to get used to them. Women should practice putting it in and removing it, prior to using it for the first time during sexual intercourse. It is recommended that FC may need to be tried up to three times before users become confident and comfortable using it.

Can a lubricant be used with female condoms and, if so, what kind of lubricant can be used?

Female condoms come pre-lubricated with a silicone-based, non-spermicidal lubricant. This lubrication helps assist in the insertion of the device and allows easy movement during intercourse. The lubricant may make FC a little slippery at first. If the outer ring of FC gets pushed in or pulled out of the vagina, more lubricant may be needed. Also, if FC makes noise during sex, simply add more lubricant. Female condoms can be used with both water-based such as KY jelly and oil-based lubricants such as Vaseline and baby oil.

What is to be done if the condom slips/ gets torn during the intercourse?

How should the condom be removed and disposed off?

To remove the condom, twist the outer ring gently and then pull the condom out keeping the sperm inside. Wrap the condom in the package or in tissue and throw it away. Do not put it into the toilet.

Can a female condom be re-used?

No, a female condom should not be re-used.

What are the disadvantages in using a female condom?

The disadvantages encountered in using the female condom are as follows: (i)The outer ring is visible outside the vagina, which can make some women feel self-conscious (ii)The female condom can make noises during intercourse. Adding more lubricant can help this problem. (iii) Some women find the female condom hard to insert and to remove (iv)It has a higher failure rate in preventing pregnancy than non-barrier methods such as the pill.

Can a female condom and a male condom be used at the same time?

You should not use two condoms at the same time. Using the condoms simultaneously may cause friction resulting in either or both condoms slipping or tearing, and/or the displacing of the outer ring of FC to the inside of the vagina.

D.SPERMICIDES

What is a spermicide?

Spermicides are chemical products inserted in a woman's vagina before sex that inactivate or kill sperm. is available in a variety of contraceptive preparations, including creams, film, foams, jellies, and suppositories which are liquids or solids that melt after they are inserted.

What is its effectiveness?

Its efficacy ranges from 80 % to 85 %. Efficacy is improved if spermicides are used in conjunction with mechanical barrier methods, most commonly condom.

What is its mode of action?

Spermicides destroy or immobilize the sperm.

Are spermicides protective against STIs and HIV/AIDS?

Spermicides are somewhat protective, but are not recommended for protection. On the contrary, using the spermicide called nonoxynol-9 many times a day,by people at risk for HIV, or for anal sex, may irritate tissue and increase the risk of HIV and other sexually transmitted infections.

How is a spermicide supposed to be used ?

Detailed instructions for correct use are included in the packaging. Be sure to read and understand them before you use any of these products. Usually, a woman lies down or squats, then gently inserts the spermicide deep into her vagina. Contraceptive foams, creams, jellies, film, and suppositories usually require waiting 10 minutes after insertion before intercourse can begin. These methods typically only remain effective for one hour after insertion. More spermicide must be inserted each time vaginal intercourse is repeated.

E. COMBINED ORAL CONTRACEPTIVE PILLS (COCs)

What are combined oral contraceptive pills?

The combined oral contraceptive pill, often referred to as "the Pill", is a combination of an oestrogen and a progesterone , taken by females by mouth to inhibit normal fertility.

How does the combined oral pill work?

The pill works mainly by (i) changing the body's hormone balance so that you do not ovulate (you do not release an egg each month from your ovary). (ii) It causes the mucus made by the cervix to thicken and form a 'mucus plug' in the cervix. This makes it difficult for sperm to get through to the uterus (womb) to fertilise an egg. (iii) The pill also makes the lining of the uterus thinner. This makes it unlikely that a fertilised egg will be able to attach to the uterus.

How effective is the combined oral pill?

It is over 99% effective if used correctly. Correct use means not missing any pills and taking the pill at the scheduled time.

What are the advantages of the pill?

The advantages of the pill are as follows: (i) It is very effective. (ii)It does not interfere with sex. (iii) Periods are often lighter, less painful, and more regular. It may relieve pre-menstrual tension. (iv) It helps to protect against some benign (non cancerous) breast disease. (v) It reduces the risk of developing certain types of cysts in the ovary. (vi)It reduces the risk of developing cancers of the ovary and uterus (womb).

Does the pill protect against Sexually transmitted infections or HIV/AIDS?

No, the pill does not offer any protection.

What are side effects when taking the pill?

Most women who take the pill do not develop any side-effects. However, some women develop minor side effects like (i) nausea (feeling sick), (ii) headaches, (iii) sore breasts (iv) tiredness (v) change in sex drive (vi) skin changes like acne and oily skin and skin pigmentation (vii) mood changes. (viii) bleeding/spotting between periods. There are certain side effects which call for immediate attention. These include: (i) severe headache,(ii) bad pains in the chest or leg,(iii) leg swelling, (iv) breathing difficulty, (v) if you cough up blood, (vi) sudden problems with sight or speech,(vii) weakness or numbness in an arm or leg.

Under what circumstances is the pill not advised?

The pill may not be advised in these circumstances. (i) if you have had previous blood clot in a blood vessel (ii) severe obesity (iii) immobility (eg wheelchair bound) (iv) poorly controlled diabetes .(v) high blood pressure (vi) if you have a close family member who has had a thrombosis, heart attack, or stroke before the age of 45 (viii) severe migraine (viii) History of smoking - particularly if you are over 35 years.(ix) Breast feeding mothers. (x) Those with history of migraine.

How are the pills used?

The combined pills usually come in a package of 28 pills. The first pill has to be taken on the 5th day of the menstrual cycle (counting the first day of bleeding as first day of the menstrual period).

Start taking the tablets from that side where START is written.

Continue to take one pill everyday at the same time for 21 days.

The last 7 pills contain iron. During this time one’s menstrual period occurs.

Start with a new pack again.

What if one forgets to take a pill?

If one forgets to take one pill, -----------it is necessary to take it as soon as one remembers and take the next pill at the usual time.

If one misses 2 consecutive pills, -----------one should take 2 pills each day for 2 days and then go back to the regular schedule.

If one misses 3 or more pills, ----------stop taking the pills and use a different birth control method until the next menstrual cycle starts. If the menstrual cycle does not start on schedule, it is necessary to get in touch with a doctor.

What is to be done if one has nausea when taking the pills?

The pills may be taken at night or with food.

How is one supposed to deal with minor headache as a side effect of taking the pill?

A painkiller such as Ibuprofen, paracetamol or other painkiller may be taken.

F. PROGESTIN ONLY ORAL CONTRACEPTIVES (MINI PILL)

What are progestin only pills?

Progestogen Only Pills or Progestin Only Pills (POP) are contraceptive pills that only contain synthetic progestins and do not contain oestrogen. They are also known as mini pills.

How do progestogen only pills work?

This contraceptive does three things. (i) First, like regular birth control pills, the progestin-only pill makes your body "think" that you are pregnant and stops your ovary from releasing an egg.
(ii) Second, the mini-pill causes changes in your uterus (where a baby grows) that makes your uterus is less likely to let a pregnancy get started even if an egg is released. (iii) And third, the progestin-only pill thickens the mucus between your uterus and your vagina. (The vagina is the passageway from the uterus to the outside of the body.) Sperm have a hard time getting through the thick mucus to reach the egg.

For whom is the Progestin only Pill suitable?

The progestin-only pill is better than regular birth control pills (i) if you are breast-feeding because the mini-pill will not change your milk production. (ii) Women who are older than 35. (iii) Women who smoke. (iv) Those with history of high blood pressure.(v) Overweight (vi) A history of blood clots

Who shouldn't take the Progestin only Pill?

Doctors may refuse to prescribe the Progestin only Pill for you: (i)If you have already had an abnormal pregnancy in which the foetus was lying outside the uterus.(ii) If you have severe artery disease, or an abnormally high cholesterol or other blood fats. (iii) If you have breast cancer.(iv) If you have unexplained vaginal bleeding.

If I use the progestin-only pill, can I still get pregnant?

Two or three of every 100 women who use the progestin-only pill correctly and consistently could still get pregnant.

Does the progestin-only pill have any disadvantages?

Progestin only pill may have the following side effects like : (i) Bleeding or spotting between the periods. This can be inconvenient, but it is not a health risk. If the bleeding seems heavy or if it bothers you, you can talk to your doctor about it. (ii) Weight gain (iii)Breast tenderness.

How is the mini pill to be taken?

Each pill package contains 28 pills. Every pill contains hormones. The mini pill can be started of the fifth day of bleeding. However, if you are sure that you are not pregnant, you can start POPs at any time during your cycle.

What are the side effects which may arise immediately following start of the pill?

When you first start POPs, as your body gets used to them, you could have minor side-effects like 'breakthrough' bleeding (bleeding between the periods) and headaches. They're not dangerous and usually go away in the first two months. If you have symptoms that persist longer, or seem severe consult a doctor.

What if pills are missed or taken late?

(i) If you are three or more hours late or you miss one POPs; take the missed pill as soon as you remember that you missed it; THEN go back to taking your POPs at your regular time. Be sure to use a backup method such as condom every time you have sex for the next 48 hours.

(ii) If you miss two or more POP's in a row; restart your POP's right away and take two pills a day for two day. Immediately start using a back-up method.If your period does not begin in 4-6 weeks, consult a doctor.

(iii) If you have unprotected sex, intercourse without a backup method, after missed or late POPs; ask your clinician about an emergency contraceptive If your period does not begin in 4-6 weeks after missing pills, consult a doctor.

G. EMERGENCY CONTRACEPTION

What is emergency contraception (or emergency birth control)?

Emergency contraception, or emergency birth control, is used to help keep a woman from getting pregnant after she has had unprotected sex (sex without using birth control).

Which are the situations that warrant use of emergency contraception?

A woman who had an unprotected sex and wants to prevent pregnancy can use emergency contraception in the following circumstances : (i) She did not expect to have sex and was not using any contraception (ii) Sex was forced upon her without her consent (iii) A condom broke or slipped (iv) She ran out of contraceptives or missed two to three birth control pills in a row.

How does emergency contraception work?

Emergency contraception can keep you from becoming pregnant by : (i) Keeping the egg from leaving the ovary (ii) Keeping the sperm from meeting the egg. (iii) Keeping the fertilized egg from attaching to the uterus (womb)

How long after sexual intercourse can emergency contraceptive pills be taken?

Emergency contraceptive measures can be taken within the first 72 hours after unprotected sexual intercourse. However it is advisable to take it as soon after unprotected sex.

What are the types of emergency contraception?

There are two types: (i) Emergency contraceptive pills (ECPs) (ii) Intrauterine devices (IUDs)

What is an Emergency Contraceptive Pill and how is it used ?

Pills containing a compound known as Levonrgestrel are made for use as emergency contraception. The two pills can be taken in two doses (one pill right away, and the next pill 12 hours later), or both pills can be taken at the same time.

How does an IUD function as an emergency contraceptive?

The IUD is a T-shaped, plastic device placed into the uterus (womb) by a doctor within five days after having sex. The IUD works by: (i) Keeping the sperm from meeting the egg (ii) Keeping the egg from attaching to the uterus (womb) . Your doctor can remove the IUD after your next period. Or, it can be left in place for up to 10 years to use as your regular birth control.

Are there any side effects when taking Emergency contraceptive pills?

The most common side effects experienced when taking EC are the following: (i) nausea and vomiting (ii) irregular vaginal bleeding (iii) fatigue (iv) headache (v) dizziness (vi) breast tenderness

How is to one deal with nausea when taking the pill?

To reduce nausea: (i) try to eat something before taking the pills (ii) take an over-the-counter anti-nausea drug before the second set of pills (iii) take the pills with milk not water

Is emergency contraception always effective?

Yes, emergency contraception s quite effective. If all 100 women use emergency contraception then only one is likely to become pregnant.

What are the danger signs one should be alert with when taking emergency contraceptive pills?

Women who experience any of the following symptoms while taking EC should call the clinic immediately: (i) Abdominal pains (severe) (ii) Unusually light bleeding in the subsequent period. (iii) If next period does not occur.

H. PROGESTIN ONLY INJECTABLES

What are Progestin only injectables?

Progestin only injectables injections containing a progesterone preparation. They are available in two varieties: DMPA. depot (Depo-Provera) which is injected every 3 months and NET-EN (Norethidrone enanthate) which is injected every 2 months.

How do Progestin only injectables work?

Progestin only injectables injections work by (i) inhibiting ovulation (ii) Cause thickening of the cervical mucus to prevent upward passage to the sperm

What are the advantages of using DMPA?

The advantages are as follows: (i) It is very effective (ii) Provides long term pregnancy protection and is reversible (iii) Convenient to use: avoids the hassles of daily intake of pills. (iv) Free from the side effects of estrogen such as danger of formation of blood clot in blood vessels. (v) Helps prevent ectopic pregnancies (pregnancy outside the uterus) and ovarian cancer.

Are there any side effects of DMPA?

Most women have some changes in their menstrual periods while using DMPA, including (i) irregular and unpredictable bleeding or spotting, (ii) an increase or decrease in menstrual bleeding, or no bleeding at all. Other possible side effects include weight gain, headaches, nervousness, abdominal discomfort, dizziness and weakness or fatigue.The absence of periods is not harmful, and periods usually return to normal after DMPA is stopped. If unusually heavy or continuous bleeding occurs, you should see your doctor.

How effective is DMPA?

DMPA is as effective as tubal ligation (having your tubes tied) and more effective at preventing pregnancy than several other methods, including birth control pills, condoms and diaphragms. It does not, however, protect against AIDS or any other sexually transmitted diseases.

Is the effect of DMPA permanent?

No. DMPA only works for about 3 months. The shot must be repeated every 3 months to prevent pregnancy. After a woman stops using DMPA, her normal ovarian function returns after a short time. However, it takes an average of 9 to 10 months to get pregnant after getting the last shot.

How is DMPA administered?

DMPA is given as 1 shot in the buttock or upper arm every thee months.

When should DMPA be started?

Situation	When to start
Having regular menstrual cycles	Any time, preferable during the first 7 days after menstruation.
After child birth, if breastfeeding	As early as six weeks after child birth
After child birth, if not breastfeeding	Immediately or at any time in the first 6 weeks after child birth
After miscarriage or abortion	Within first 7 days after first or second trimester miscarriage or abortion.

Who are eligible to use DMPA?

DMPA can be used safely by women who: (i) Are breastfeeding (ii) Smoke cigarettes (iii) Have no children (iv) Any age group- from adolescents to those over 40 years of age (v) have benign breast disease (vi) have mild to moderate blood pressure

Who should not use DMPA?

Women who have any of the following should not use DMPA: a history of jaundice, blood clots, vaginal bleeding without a known reason, cancer of the breast or reproductive organs, known or suspected pregnancy, or allergy to the medication in DMPA.

I. INTRA UTERINE DEVICE

What is an intrauterine device?

An intrauterine device, called an IUD for short, is a small, plastic, T-shaped device with a string attached to the end. The IUD is placed inside the uterus to prevent pregnancy. This placement can be done during an office visit. Once in place, the IUD stays in your uterus until your doctor removes it.

How does it work?

The IUD prevents sperm from joining with an egg. It does this by making the sperm unable to go into the egg and by changing the lining of the uterus.

What are the types of IUDs?

The different types of IUDs are: (i) Copper bearing IUDs- These contain a copper wire inserted inside a plastic tube (ii) Hormone releasing IUDs (newer form of IUDs) : These are made of plastic and contain small amounts of hormone progesterone.

What are the advantages of a hormonal IUD over Copper IUD?

Hormonal IUDs are: (i) More effective than Copper bearing IUDs. (ii) Make the menstrual period lighter.

What are the disadvantages of a hormonal IUD over Copper IUD?

Hormonal IUDs are (i) costlier as compared to Copper IUD (ii) Can cause irregular bleeding or spotting in the first six months of use.

What are the advantages of an IUD?

The IUD has many advantages: (i) It's very effective in preventing pregnancy, (ii )Convenient –no hassle of taking the pill is involved. (iii) It's inexpensive. (iv) An IUD can be removed by your doctor at any time. (v) It starts working right away. (vi)There's a low risk of side effects. (vii) Mothers who use an IUD can breast-feed safely.

How effective is an IUD in preventing pregnancy?

The IUD is one of the most effective methods of contraception. The IUD has been found to be as much as 99% effective when inserted properly.

How long is an IUD effective?

It depends on the kind your doctor prescribed to you. The copper IUD – TCU 380A, which is now available under the National Family Welfare Programme can remain in your body as long as 10 years. The hormonal IUD needs to be replaced every 5 years. Your doctor can remove either of these at any time if you decide to get pregnant or if you no longer want to use it.

What are the disadvantages?

The disadvantages are as follows : (i) You may have cramps and backache for the first few hours after an IUD is put in your uterus. (ii) Some women have bleeding for a couple of weeks after the IUD is inserted, and heavy periods after that. (iii) Rarely, the uterus can be injured when the IUD is put inside. (iv)The IUD doesn't protect you from AIDS or any other sexually transmitted diseases. In fact, these infections can be more serious in women who have an IUD. In addition, the more people you have sex with, the greater your chance of getting an infection if you have an IUD.

Who are eligible to use an IUD for contraception?

IUD can be used in any circumstances by women who: (i) are breastfeeding (ii) Smoke (iii) Have any of the medical conditions like high blood pressure, heart disease, liver or gall bladder disease, diabetes, epilepsy.

What is the ideal time for insertion of an IUD ?

The ideal time for insertion of an IUD is as follows:

1.Having menstrual cycles: Any time during menstrual cycle within first 12 days after the start of menstrual bleeding.

2.After child birth / abortion : Any time within 24 hours after childbirth.

How is the IUD fitted?

This is usually done towards the end of a period or shortly after. However, it can be fitted at any time provided that you are certain you are not pregnant. You will need to have a vaginal examination. The doctor or nurse will pass a small instrument into your uterus to check its size and position. An IUD is then fitted. You will be taught how to feel the threads of the IUD so you can check it is in place. It is best to check the threads regularly, for example, once a month just after a period.

When is a woman advised to check that her IUD is in place?

A woman is advised to check her IUD : (I) once a week during the first month after insertion (ii) After noticing any unusual symptoms (iii) After a menstrual period.

What precautions are to be taken by a woman to check that her IUD is in place?

To check her IUD, a woman should: (i) Wash her hands (ii) Sit in a squatting position (iii) Insert 1 to 2 fingers in her vagina as far as she can until she feels the strings (iv) Wash her hands again.

When is a woman who has had her IUD inserted advised to consult a doctor?

A woman is advised to consult a doctor if: (i) her sex partner feels the IUD strings during sex and this bothers him (ii) Heavy or prolonged bleeding that bothers the client (iii) Increasing or severe pain in the lower abdomen , especially if associated with fever (iv) Missed a menstrual period (v) Vaginal discharge with an unpleasant odour (v) Wants to opt for some other family planning method or would like to have the IUD removed.

J. CENTCHROMAN

What is Centchroman?

Centchroman is a novel non - steroidal once - a – week oral contraceptive unrelated to hormonal oral contraceptives.

What are the advantages of using Centchroman?

Centchroman s safe and free from typical hormonal side effects such as nausea, weight gain, fluid retention, high blood pressure etc.

When must Centchroman NOT be used?

Administration of Centchroman is not recommended in the following conditions: (i) Recent history of clinical evidence of jaundice or liver diseases. (ii) ovarian disease (iii) Tuberculosis (iv) Kidney disease.

How should these pills be taken?

Regimen should be started with 1 tablet of 30 mg twice a week for 3 months followed by one tablet once a week as long as contraception is desired. The first tablet has to be taken on the first day of the menstrual cycle. Tablet should be taken on fixed days and at fixed times. Dosage should be followed irrespective of subsequent menstrual periods.

What are its side effects?

Some of its side effects are: (i) Prolongation of menstrual cycles (ii) Delayed menstruation. In case of delay exceeding 15 days, a doctor should be consulted to rule out pregnancy.

K. FEMALE STERLIZATION - TUBAL LIGATION

What is Tubal Ligation?

Tubal ligation, commonly knows as “getting your tubes tied,” is a surgical sterilization technique for women. This procedure closes the fallopian tubes, and stops the egg from traveling to the uterus from the ovary. It also prevents sperm from reaching the fallopian tube to fertilize an egg.

How reliable is female sterilization?

Female sterilization provides permanent contraception for women who do not want more children.It is more than 99% effective. About 1 in 200 women will become pregnant after sterilization. This is because the tubes can, rarely, come back together again after being cut or blocked.

How is it done?

There are 2 methods of tubal ligation done under local or spinal anesthesia : (I) A minilaparotomy involves making a small incision in the abdomen, locating the tubes, and cutting and closing them off. (ii) A laparoscopic tubal ligation involves inflating the abdomen with carbon dioxide or nitrous oxide gas, making a small incision in the abdominal wall, and inserting a fiberoptic light and an instrument that coagulates the tubes with an electric current or puts a clip or plastic band around the end of each tube.

What are the advantages of female sterilizations?

It is permanent and you don't have to think of contraception again.

What are the disadvantages of female sterilization?

As it is permanent some people may regret having the operation in future years, particularly if their circumstances change. It is also not as easy to reverse as compared to male sterlization.

How soon is it effective?

You must continue to use other forms of contraception until your next period occurs after the operation.

Will sterilization change a woman’s monthly periods or make her menstrual bleeding stop?

No, sterilization has no such impact on a woman’s monthly period.

Will it reduce my sex drive?

No. Sex may be more enjoyable as the worry or inconvenience of other forms of contraception is removed.

L. MALE STERLIZATION- VASECTOMY

What is a vasectomy?

A vasectomy is an operation that make a man permanently unable to get a woman pregnant. It involves cutting the 2 tubes called vas deferens so that sperm can no longer get into the semen.

How is a vasectomy done?

A vasectomy is usually done as an outpatient procedure . The operation takes about half an hour. You'll be awake during the procedure. Your doctor will give you a local anesthetic to numb your scrotum. After this, your doctor will cut a small opening (an incision) on one side of your scrotum and pull out part of the vas deferens on that side. You may feel some tugging and pulling. A small section of the vas deferens is removed. The ends of the vas deferens will be sealed by stitching them shut, by searing them shut with heat, or by using another method. Your doctor will then do the same thing on the other side. Your doctor will close the 2 openings in your scrotum with stitches

What is no-scalpel vasectomy?

The no-scalpel vasectomy involves making a very small puncture (a hole) in the scrotum instead of an incision. The puncture is so small that it heals without stitches.

How effective is vasectomy in preventing pregnancy?

Vasectomy may be the safest, most effective kind of birth control. Only about 15 out of 10,000 couples get pregnant the first year after a vasectomy.

Are there any reasons why one shouldn't have a vasectomy?

Don't have a vasectomy unless you're sure you don't want to have children in the future. Also you may have delay in getting a vasectomy done if you have an infection on or around your genitals, or you have a bleeding disorder.

Can vasectomy be reversed?

Some vasectomies can be undone, or "reversed," but the surgery is expensive and hard to access. Even though most men can ejaculate sperm after the reversal surgery, the sperm are often not able to fertilize an egg.

How should I prepare for the operation?

On the day of the operation, bring a snug underwear with you and make sure your genital area is clean. Your doctor will probably give you instructions on how to clean the area before you come in. Your doctor may suggest you bring someone to drive you home after surgery.

What can I expect after the operation?

Right after the operation, your doctor will have you lie down for a couple of hours with an ice pack placed on your scrotum. You may have some bruising in the area of the surgery. The bruises should slowly lighten and be gone in about 2 weeks. You should feel back to normal within a couple of weeks.

When can I go back to work?

Rest is to be taken for 2 days. Heavy work or vigorous exercise should be avoided for a few days.

Will the vasectomy work right away?

No. You'll need to ejaculate as many as 15 to 20 times before the sperm will be cleared from both the vas deferens. For that reason, it is important to use condoms or any other family planning method for 3 months after the procedure.

What are the side effects of a vasectomy?

Problems that might occur after your vasectomy include (i) bleeding,(ii)Pain (iii) infection

Apart from the usual follow up, which are the conditions for which a man who has undergone vasectomy must consult a doctor?

Call your doctor if: (i) You have a fever. (ii) You have swelling that won't go down or keeps getting worse. (iii) You have trouble urinating. (iv) You can feel a lump forming in your scrotum. (v) You have bleeding from an incision that doesn't stop even after you've pinched the site between 2 gauze pads for 10 minutes.

Will a vasectomy affect one’s sex life?

After you have healed from the vasectomy, your sex life shouldn't change at all. You'll still ejaculate almost the same amount of semen as you did before, and you won't notice a change in your sex drive.

What happens to the sperm after vasectomy?

Once sperm can't get through the vas deferens, your testicles will begin making fewer sperm. Your body will absorb the sperm that are made.

Is it better for a man to have a vasectomy or for a woman to be sterilized?

Each couple must decide for themselves which method is best for them. Both are very effective, safe and permanent. However, vasectomy is simpler and safer to perform that female sterilization. Also it is less expensive and slightly more effective.

Does vasectomy increase the risk of prostrate cancer?

No, vasectomy does not increase the risk of prostrate cancer.

Can an HIV infected person undergo vasectomy?

Yes an HIV infected person can undergo vasectomy

M.NATURAL FAMILY PLANNING METHODS

What are natural family planning methods?

Natural family planning methods are methods in which a woman tries to avoid intercourse during the fertile time of her menstrual cycle.

When is a woman said to be fertile?

A woman is fertile when she is ovulating and for a few days before ovulation. Ovulation usually occurs mid cycle. More precisely, ovulation usually occurs 14 days before the onset of bleeding.

What are some of the common natural family planning methods?

The common natural family planning methods include: Rhythm Method, cervical mucus method, Basal Body temperature (BBT) Method, Standard Days Method (SDM).

What is Rhythm Method?

The rhythm method is based on the idea that women ovulate 14 days before menstruation begins. Based on this assumptions, the rhythm method requires a woman to count back 14 days from the first day of her period. This will presumably be the day on which she ovulated and will ovulate the following month. In order to avoid pregnancy, she will need to abstain from sex or use another form of birth control, like condoms around this time.

What are the drawbacks of the rhythm method?

The rhythm method has a high failure rate of 13 to 20%. It is not recommended for women who have irregular cycles or who do not have menstrual cycles that are exactly the same number of days every month.

What is cervical mucus method?

The cervical mucus method is based on the idea that near the time or at the time of ovulation, your cervical mucus will become thinner and stickier your cervical mucus will be clear, slippery and very stretchy, similar to a raw egg white. Thus, If you do not want to get pregnant, then sex should be avoided from the time you begin to notice the slippery, stretchy mucus until at least two days after it is gone.

How can the cervical mucus be tested?

Use your finger or toilet paper to wipe across the opening of vagina and then take a look at the mucus. Examine the consistency and try to stretch the mucus between your fingers. If you can stretch it at least three inches without it breaking, then ovulation is about to occur.

What are the drawbacks of the cervical mucus method?

This method has a high failure rate of about 20 %.

What is Basal Body temperature (BBT) Method?

The BBT Method is based on the fact that the body temperature rises about 0.5 degree to 1 degree above the body temperature around the time of ovulation. Seeing a sustained increase in your temperature, one that lasts for at least three days, indicates that ovulation has taken place. When you know ovulation has taken place, it can be assumed that having sex during the rest of your menstrual cycle will not result in pregnancy.

How is the Basal Body temperature (BBT) Method performed?

A woman needs to take her temperature every day, first thing in the morning before she gets out of bed. Once you have taken your temperature, record it on a chart so that you can follow the fluctuations in your temperature from day to day. Avoid sex during the days when the body temperature is steadily high and for 7 days thereafter.

What is the effectiveness of the BBT Method?

On average, the basal body temperature method has a failure rate of 15% but as low as 2% per year for perfect users

What is the Standard Days Method (SDM)?

The Standard Days Method is a new natural family planning method for women with menstrual cycles ranging between 26 and 32 days. This method involves identifying the fertile days during each menstrual cycle. Women with menstrual cycles between 26 to 32 days can prevent pregnancy by avoiding unprotected sexual intercourse on days 8 to 19.

How is the Standard Days Method practiced?

The Standard Days Method is fairly straightforward to use. There are two methods which can be practiced:

(i) Conventional Method: Keep track of how long your menstrual cycle is, in order to determine when Days 8 through 19 occur. (i) When the first day of your period arrives, this is Day1 of your cycle. Mark this on your calendar. (ii) Between Day 1 and Day 7, it is highly unlikely that you will become pregnant, so it is safe to participate in sexual intercourse without using birth control. (iii) Between Day 8 and Day 19, you are at your most fertile. You and your partner should abstain from sex or you should use an alternate type of birth control, such as a condom. (iv) Between Day 20 and 32 you are unlikely to get pregnant, so you can resume sexual intercourse.

(ii) Cycle Beads:. Cycle Beads are a string of 32 color-coded beads, shaped into a necklace. There is a rubber ring that can be placed around individual beads on the necklace to help identify what day you are on in your cycle. There are three colors of beads on the Cycle Bead necklace: (a) Red: There is one red bead on the Cycle Bead necklace. This red bead stands for the first day in your menstrual cycle. It is on this day that you get your menstrual period. (b) Brown: The brown beads signify the days during your cycle when it is highly unlikely that you will get pregnant. (c) White: The white, glow-in-the-dark beads represent the fertile days of your menstrual cycle (Days 8 to 19). As you move through each day of your cycle, you slip the rubber ring on a different bead. When the rubber ring is moved onto the white beads, you will know to abstain from sex or to use a form of contraception.

Who Can Use the Standard Days Method?

The Standard Days Method can be used by the majority of women, however, before you try the method it is important that you meet the following criteria: (i) Your menstrual cycles are regular (ii) Your cycle is between 26 and 32 days long (SDM is less effective if your cycles are shorter than 26 days or longer than 32 days). (iii) You and your partner are willing to abstain from intercourse or use protection during your fertile days.

How Effective is the Standard Days Method?

When used regularly and consistently, SDM has been shown to be a highly effective birth control method. When used perfectly, only five out of every 100 women will get pregnant. This means that the method is 95% effective against pregnancy. If you do not follow the method consistently, or if your cycle falls outside of the 26 to 32 day range, SDM will be less effective, that is about 88 %.

PREGNANCY N RELATED INFO.

2008-11-02T01:47:00.000-07:00

A. PREGNANCY TESTS

What are pregnancy tests and how do they work?

Pregnancy tests look for a special hormone in the urine or blood that is only there when a woman is pregnant. This hormone, human chorionic gonadotropin (hCG), can also be called the pregnancy hormone. The pregnancy hormone, hCG, is made in your body when a fertilized egg gets attached to the uterus. This usually happens about 6 days after conception

What are Home Pregnancy tests (HPTs)?

Home Pregnancy tests are do-it-yourself tests which can be conveniently done at home. They are easily available over the counter and cost approximately between 45-50 rupees. A woman is supposed to collect just about 5 ml of her urine in a clean container and perform the test using put one to two drops of the urine into a special container provided in the kit. Then the woman needs to wait a few minutes. Different brands instruct the woman to wait different amounts of time. Once the time has passed, the user should inspect the "result window." If a line or plus symbol appears, you are pregnant. It does not matter how faint the line is. A line, whether bold or faint, means the result is positive.

How soon after a missed period can I take a home pregnancy test and get accurate results?

Many home pregnancy tests (HPTs) claim to be 99% accurate on the day you miss your period.

If one gets a negative result on a home pregnancy test can she still be pregnant?

Yes. So, most HPTs suggest women take the test again in a few days or a week

B.EARLY PREGNANCY:FIRST TRIMESTER

What are the early symptoms of pregnancy?

Most women equate a missed menstrual period with the possibility of being pregnant, but other symptoms and signs are experienced by most women in the early stages of pregnancy. These include: (i) Feelings of breast swelling, tenderness, or pain (ii) Nausea and vomiting traditionally associated with morning sickness (iii) Frequent urination. (iv) Fatigue and tiredness (vi) Food aversions or cravings (vii) mood swings (viii) deepening of the colour of the area around the nipple (ix) Pigmentation of the face

Is a missed menstrual period always the first sign of pregnancy?

A missed menstrual period is most often the first sign of pregnancy, although a woman may still experience some bleeding or spotting around the time of the expected period. However, if a woman does not have regular menstrual cycles, she may notice some of the other symptoms of early pregnancy before it is apparent that the menstrual period has been missed.

How can one determine the due date of delivery ?

A pregnancy generally lasts for 40 weeks from first day of your last menstrual period, If you know the date of your last menstrual period, and your cycles are regular, you should be able to determine your due date sitting at home. Based on LMP : If your cycles are regular and 28 days long, then you can determine your due date by adding 9 months and 7 days to the first day of your last menstrual period (LMP). For example, if your LMP began on September 5, then your expected due date (EDD) would be June 12 of the following year.

Does nausea and vomiting always occur in the morning during early pregnancy?

The nausea and vomiting associated with early pregnancy can occur at any time of the day or night.

How could one cope with the nausea and vomiting associated with pregnancy?

Try some of these tips to help prevent and soothe nausea: (i) Eat frequent, small meals (6 to 8 small meals a day) rather than 3 large meals. (ii) Avoid fatty, fried, or spicy foods. (iii) Try eating starchy snacks like rusk/toast when you feel nauseated. Keep some by your bed and eat them before you get out of bed in the morning. If you feel nauseous in the middle of the night, reach for these starchy foods. (iv) Get out of bed slowly. (v) Try to suck a lemon when in case you have nausea.

Should a doctor be consulted for nausea and vomiting?

A doctor should be consulted if you think that you are vomiting too much. Excessive vomiting can lead to dehydration for which hospitalization may be required.

Why does frequent urination occur in pregnancy?

Early in pregnancy, the growing uterus presses on your bladder. This causes frequent urination.

C.SECOND TRIMESTER

What are the signs and symptoms of the second trimester of pregnancy?

During the second trimester: (i)Nausea/vomiting and fatigue become less (ii) Abdominal expansion (iii) Weight gain (iv) Backache (v) Stretch marks on the abdomen (vi) Skin pigmentation on the face.

D.THIRD TRIMESTER

What are the signs and symptoms of the second trimester of pregnancy ?

During the third trimester, the following signs and symptoms are manifested (i) Breathing becomes more difficult due to pressure by the growing baby (ii) Frequent urination (iii) Burning pain in the chest (iv) constipation (v) Swollen tender breasts (vi) Trouble sleeping. (vii)Abdominal contractions

What is premature labour?

Pre mature labour is referred to as onset of delivery before the 37th week.

What are the symptoms of premature labour ?

The symptoms of pre mature labour include: (i) Pain or pressure in the lower back (ii) Pressure in the thighs (iii) A vaginal discharge that is watery, pinkish and brownish (iv) Menstrual-like cramps, nausea, diarrhoea or indigestion (v) A rupture of membranes in your vagina.

Why do abdominal contractions occur?

Abdominal contractions are painless which start as early as the 10th week but are clearly appreciated in the last trimester. When these contractions become more frequent & intense , they could even be mistaken for the beginning of real labour.

E. ALARMING SIGNS

Which are the symptoms which can indicate danger in pregnancy?

The following symptoms may be signs of a serious condition : (i) Vaginal bleeding or spotting.(ii) Sudden weight gain (iii) persistent headache (iv) blurred vision (v) sudden swelling of hands/ feet. (vi) Prolonged vomiting (vii) High fever with chills (viii) Sudden intense abdominal pain in early pregnancy (ix) Inability to appreciate foetal movements.

What does vaginal bleeding or spotting indicate?

Vaginal bleeding or spotting in the early months accompanied by abdominal pain may be a warning sign of a possible abortion. Vaginal bleeding in the later months may indicate a low lying placenta or separation of placenta from the uterine wall.

What do sudden weight gain, persistent headache , blurred vision , sudden swelling of hands/ feet indicate?

These symptoms may indicate high blood pressure in pregnancy, a condition also known as toxemia. A woman with these symptoms may need to be hospitalized to bring down her blood pressure or for fetal testing. Toxemia could result in complications like inadequate fetal growth, premature labour or fetal distress during labour.

Why is high fever dangerous in pregnancy?

High fever accompanied with chills and without symptoms of cold may be indicative of an inflammation of the membranes around the foetus, known as amnionitis. This can be potentially dangerous for the foetus and result in pre mature labour.

F. ROUTINE TESTS

What diseases are regularly tested for even during a normal pregnancy ?

Some of the conditions routinely checked for in most normal pregnancies are AIDS, Hepatitis B, Syphilis, Rh Incompatibility and Rubella. The doctor can test for all these condition with blood samples, taken at different times in the pregnancy.

When should one be worried about congenital diseases ?

Your baby has a higher chance of having congenital disease if he falls in any of the three reasons: (i) Congenital diseases in the previous baby (ii) History of congenital anomalies in the family which are likely to be repeated (iii) Maternal age is above 35, then there is a higher chance of the baby getting Down's syndrome .

Can birth defects be detected with regular blood tests ?

Studies have shown that 90 % of birth defects cannot be detected through prenatal blood tests. In order to isolate the remaining 10 % of the identifiable birth defects, there are four main types of tests: amniocentesis, chorionic villi sampling, certain blood tests like the Alpha feto-Protein (AFP) test, and ultrasound scans.

G. GENERAL CARE

Why is so much stress laid on a healthy diet?

As you are the only source of nutrition for your unborn baby, your eating habits will affect your baby's health and well-being. In order to cope with the increased demands, your body needs a sufficient amount of nutrition

How many calories does an expectant mother require ?

A. In the early months of pregnancy, you do not need to change your diet. However, as the pregnancy advances, you may need to increase your calorific intake to 300 additional calories a day. This normally happens in the second and third trimesters. If you eat more than this amount, it is you who will gain the unnecessary weight, and not your baby. So make sure that you avoid junk foods like burgers, fries, cookies, etc. as these constitute empty calories. What you need is a sufficient amount of proteins, carbohydrates and foods that contain minerals and vitamins such as chappatis, pulses, soy, milk, eggs, non veg foods, nuts, green leafy vegetables and fresh fruits.

They say that a pregnant woman eats for two ?

Your pregnancy does not entitle you to eat for two. In fact, if you do eat for two, you will gain so much weight that you will not only be inviting unnecessary complications, but will also have difficulty in shedding your excess weight after pregnancy.

What is a balanced diet for a pregnant woman?

During pregnancy, your diet should consist of the following

3 helpings of first class proteins –egg, soyabean, non-veg item
2 helpings of vitamin C foods –citrus fruits/ tomatoes
4 helpings of calcium-rich foods (4 during pregnancy, and 5 during lactation) –milk, curd
3 helpings of green, leafy and yellow vegetables or fruits –spinach, bathua, cholai, pumpkin, papaya, carrot
½ serving of other fruits and vegetables –brinjal, bottleguard, cabbage.
4-5 helpings of whole grain and complex carbohydrates –chappatis, rice.
8-10 glasses of water
Dietary supplements based on your doctor's recommendation

Which dietary supplements does a pregnant woman need to take ?

A pregnant woman requires vitamins, iron and calcium in her diet. Iron-folic acid tablets and Calcium tablets are available free of cost at all government health centers. These supplements are also available over the counter. A doctor should be consulted for prescribing these dietary supplements.

What is the ideal weight gain for a healthy pregnancy ?

A woman should gain anywhere between 11-14 kg on average.

What is the optimum trimester wise weight gain?

The optimum trimester wise weight gain is as follows: (i)First trimester: 1-2 kg (ii) Second trimester: 5-7 kg (iii) 4-5 kg

Is it safe to drink tea/coffee or fizzy drinks during pregnancy?

Consumption of tea, coffee and fizzy drinks should be limited during pregnancy.

How can one cope with craving for foods that are less nutritious?

If you have a craving for something unhealthy, first try to distract yourself or find a healthy alternative. If it still persists, you may give in just a little bit but whatever you do, do not compromise upon your baby's nutritional needs

What is one supposed to do if there is a bizarre craving for peculiar non edible items?

A doctor should be consulted as this may be a sign of an underlying nutritional disorder.

How can constipation be relieved during pregnancy?

As many as half of all pregnant women have problems with constipation. General Some treatment measures include: (i) Drink at least 8 glasses of water each day, including 1-2 glasses of fruit juice (ii) Include bulk foods, foods high in fiber, such as cereals, and raw fruits and vegetables. (iii) Exercise daily-walking is a good form of exercise. Exercise and good physical fitness helps to maintain healthy bowel patterns. (iv) For occasional constipation, you may use a stool softener laxative as prescribed by your doctor.

Is it normal for gums to swell and/or bleed during pregnancy?

The extra hormones in the body during pregnancy may cause the gums to swell and bleed. Brush regularly, using a soft toothbrush. Having a dental checkup early in pregnancy is a good idea to be sure your mouth is healthy.

What can be done to prevent burning pain in the chest?

To prevent burning pain in the chest: (i) Eat small frequent meals, 5 or 6 per day instead of 2 or 3 large meals. Avoid drinking large amounts of fluids with meals. (ii) Avoid foods that cause gas and spicy or greasy foods. (iii) Do not eat or drink before bedtime. (iv) Wait 2 hours after eating before exercising. (v) No alcohol or smoking. (vi) Avoid very hot or very cold fluids.

Is it safe to continue to have sexual intercourse during pregnancy?

Some couples worry about having intercourse during pregnancy. They may be afraid that it will cause a miscarriage. For a healthy woman with a normal pregnancy, intercourse is safe into the last weeks of pregnancy. You and your partner may want to experiment with different positions that may be more comfortable for you.

Are leg cramps common in pregnancy?

Yes, you may find that you have an increase in leg cramps in the second and third trimesters of pregnancy. Get plenty of calcium (three glasses of milk or supplement) and potassium (bananas and oranges). Stretching your legs before going to bed may help relieve cramps.

May one travel during pregnancy?

Most women can travel safely until close to their due date. Frequently, the most comfortable time to travel is in the middle of pregnancy. Problems are least likely to happen during this time.

Why should one exercise during pregnancy ?

The exercises are aimed at the following: (i) Improving posture and appearance (ii) Relieving back pain (iii) Strengthening muscles for delivery and for supporting loosened joints (iv) Relieving muscle cramps (v) Enhancing circulation (vi) Increasing flexibility (vii) Increasing energy level by combating fatigue (viii)Promoting feelings of well-being and developing a positive self image .Your doctor will advice you about the right kind of exercise.

Will exercise benefit my baby ?

Yes. Exercise is extremely good for the foetus because it causes blood flow to increase and improve the baby's growth and development. Exercise also makes the baby's brain and other tissues start functioning in optimum condition.

What kind of exercise is safe during pregnancy?

Continuing any sport or mild form of exercise should not be a problem, as long as it is done in moderation. However you must first consult your doctor

What kind of exercises should one totally avoid ?

Exercises like jogging is very hard on the spine, pelvis, hips, knees, breasts and back and should be avoided. Exercises that pull your abdominal muscles, like leg lifts and sit-ups, are also not advisable during pregnancy. Further, do not try your hand at any new sport once you get pregnant; your body needs time to adjust to new movements. After the 4th month, do not exercise while lying flat on your back, as the weight of your uterus can compress major blood vessels, and restrict circulation.

How long can I continue working after I am pregnant?

Pregnant women who have no complications can continue working until the ninth month. They must however, take certain precautions such as avoiding strenuous activity, stair-climbing, extreme temperatures and smoky areas. They must also take frequent breaks and leave early if they are feeling exhausted. If they have been standing for a prolonged period, they should sit down and put their feet up. Standing for extended periods, lifting heavy objects, stooping and bending should be avoided in the last three months. Pregnant women must eat regular meals. A sedentary job that is not particularly stressful may be less of a strain than staying at home.

What relaxation techniques are helpful during pregnancy ?

The following techniques are helpful in pregnancy: (i) Lie on your back with your head on the cushion and your lower legs raised on a chair. Close your eyes and relax for 10-15 minutes. This exercise will also help relieve swollen ankles and feet. (ii) Lie on your side and keep a pillow underneath your head. Bend your upper arms and legs upwards, placing a pillow under this knee. Keep your lower leg straight. Close eyes and clear your mind. Breathe in and count to 10. Breathe out slowly. Relax completely.

Why do doctors recommend that a pregnant woman should sleep on her left side?

Although sleeping on the back may be more comfortable to start with, it leads to backaches and haemorrhoids, and inhibits digestion, breathing and circulation .This is because the entire weight of the uterus on the back. Whereas, stretching out on your left side, allows maximum flow of blood and nutrients to the placenta, enhances the functioning of the kidneys, which leads to better elimination of waste materials (which in turn would cause swelling ). So this should be, technically, the most comfortable position.

H. HIV AND PREGNANCY

If the mother is HIV positive , what are the chances for the baby to become HIV positive?

There are 25 % chances that the baby will become HIV positive.

What are the options available to an HIV positive mother to reduce the chances of transmission of infection to her baby?

Women with HIV should receive during pregnancy whatever antiviral chemotherapy is recommended according to current adult guidelines. Then in addition, they should receive intravenous therapy with an antiviral starting about 3 hours before and then during the Cesarean delivery. The baby will then receive oral antiviral syrup for the first 6 weeks of life. Right now this is the best therapy for minimizing HIV infection in the newborn. Delivery by caesarean section is also advised.

What are the chances of infection to the infant if the women is on anti viral therapy and undergoes C- section?

When Anti viral therapy is given to a woman during pregnancy, the incidence of infection is reduced to about 5-8%. When C-section is performed and antiviral therapy is given during labor, the infection rate is further reduced to about 2%.

I. LABOUR

What is labour?

Labour can be said to be a series of events that take place in different organs in an effort to expel a live baby out of uterus through the vagina into the outer world.

What is pre term labour?

Pre term labour occurs before 37 weeks of pregnancy.

What is Caesarean Section?

Caesarean section (C-section) is the delivery of a baby through a cut in the mother’s lower abdomen and the uterus.

What are the conditions for which a planned caesarean section is done?

Following are the conditions for which a planned caesarean section is done

Previous 2 or more caesareans.

Low lying placenta

Mal-presentations of your baby .

Small pelvis

Underlying conditions like Pregnancy induced Hypertension, diabetes.

For the conditions for which an emergency caesarean section is done?

Following are the conditions for which an emergency caesarean section is done :

Distress of the foetus: Your baby may not be tolerating the forces of labour well, and may show problems like irregularity or slowing of the heart rate, or acid in the blood. Sometimes greenish discolouration of the amniotic fluid (passage of meconium or foetal stools in utero) may be a sign of distress. If vaginal delivery cannot be completed quickly, a caesarean may be the best way to save your baby.

Non-progress of labour

Bleeding from the placenta

J. BREAST FEEDING RELATED CONCERNS

How long after delivery must breastfeeding be initiated?

Breastfeeding may be initiated at least half an hour following normal delivery and 4 hours following caesarean section.

How often should one breastfeed?

Daytime every two to three hours for at least 10-15 minutes on each breast. You may need to wake your baby (a diaper change and holding baby upright and talking to baby helps waken baby) during the day so your nights will be more restful. As baby's nutritional needs are better met during the day, baby will not wake as often during the night. Sometimes your breasts will be full during the night and baby may still be asleep so you will want to wake your baby and nurse. As baby gets older, feedings will space out.

How can breast engorgement be prevented?

Breast engorgement can be prevented by increasing the frequency of breast feeding such as every one and a half to 2 hours till the engorgement subsides.

How can I tell if my baby is getting enough milk?

If your baby has four to six wet diapers in a 24-hour period, it means that you are supplying the baby with a good amount of breast milk. Another sign that there is good milk transfer is your breasts soften with nursing.

Does baby get anything before milk comes in?

Yes, your breasts supply colostrum, a very concentrated milk full of antibodies. This colostrum acts as a laxative, helping clear meconium (black tarry stool) and bilirubin (which may make baby jaundiced or yellow) from your baby.

What is post partum breast infection and what is its cause?

Post partum breast infection occurs when bacteria lodged on the nipple get into a breast through a crack on the nipple or through a duct when breastfeeding.

What are the symptoms of post partum breast infection?

It is characterized by pain and swelling of the breasts, redness of the overlying skin and may/ may not be associated with fever.

What is to be done in case of a post partum breast infection?

Breastfeeding should be continued and a doctor should be consulted for prescription of antibiotics.

What happens if prompt treatment is not sought?

If prompt treatment is not sought, it may lead to development of a breast abscess.

What causes sore nipples?

When you are first learning to breastfeed, sore nipples are the result of poor positioning.

How can sore nipples be managed?

Sore nipples can be managed by Properly position baby's gums over the center of the nipple where the milk is pooling, not the tip of the nipple where you have lots of nerve endings

Why does the baby get suddenly hungry?

Babies have growth spurts, usually between 1-2 weeks old, at 6 weeks old, and 3 months old. Baby may want to nurse twice as often for 1-2 days during that time, and this extra stimulation will automatically increase mother's supply to match baby's demands.

What causes breast lumps during nursing and how can it be managed?

Lumpy breasts can be normal when nursing and is caused due to a plugged duct. Before nursing, use heat (warm shower or warm compress) and breast massage (gentle circular motion with fingertips from chest wall, over lump towards nipple) then nurse or pump. It is important to clear a plugged duct because it can lead to a breast infection. If the lump doesn't clear with this treatment or you develop flu-like symptoms, call the doctor.

K. OTHER POST PARTUM RELATED CONCERNS

How long will the perineal pain from delivery last so I can know how long before I can resume intercourse?

In general, you should expect that it takes about month before perineal discomfort with walking or sitting goes away but it may easily take 2 months. Also it will take about 3 months before the discomfort with vaginal intercourse goes away but it may be 6 months or more.

What causes pain with urination, frequency, vulvar burning after delivery ?

The hormones of pregnancy, high estrogen and progesterone, decline rapidly after delivery resulting in dryness of the vagina and inner mucosal lining of the vulva. As a result, it becomes sensitive to any irritation from soaps, rubbing, or contact with chemicals in pads, condoms, lotions or other topically applied agents.

Do women suffer from uncontrolled passing of gas or even stool from the anus after delivery.?

After vaginal delivery, some women do have difficulty holding their stool or gas. It occurs much more commonly after injury to the anal sphincter muscle, even if that injury is surgically repaired at the time of delivery

What can be done about the vaginal opening looseness or pelvic prolapse after delivery ?

For this, a doctor/physiotherapist should be consulted who will advice about Kegels exercise to reduce the muscle tone.

MENOPAUSE N REALTED INFO.

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What is menopause?

Menopause is defined as absence of menstrual periods for 12 months. Menopause is the time in a woman's life when the function of the ovaries ceases.

At what age does a woman typically reach menopause?

Most women reach menopause between the ages of 45 and 55, but menopause may occur as earlier as the 30s or 40s or may not occur until a woman reaches her 60s.

What are the signs and symptoms of menopause?

It is important to remember that each woman's experience is highly individual. Some women may experience few or no symptoms of menopause, while others experience multiple physical and psychological symptoms. The extent and severity of symptoms varies significantly among women. Some of the signs and symptoms are discussed below:

Irregular vaginal bleeding: Menstrual periods (menses) may occur more frequently (meaning the cycle shortens in duration), or they may get farther and farther apart (meaning the cycle lengthens in duration) before stopping

Hot flashes and sweating: A hot flash is a feeling of warmth that spreads over the body and is often most pronounced in the head and chest A hot flash is sometimes associated with flushing and is sometimes followed by perspiration. Hot flashes usually last from 30 seconds to several minutes.

Dryness of the vagina walls

Burning sensation during passing of urine

Sleep disturbances

Weight gain

Mood changes: irritability, fatigue, diminishes memory.

Weakening of bones

What is Hormone Replacement Therapy in treatment of symptoms of menopause?

Hormone therapy (HT) , also referred to as hormone replacement therapy (HRT) or postmenopausal hormone therapy (PHT), consists of estrogens or a combination of estrogens and progesterone (progestin).

What are the risks associated with HRT?

Studies of women receiving combined hormone therapy with both estrogen and progesterone have shown that these women had an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive HT. Later studies of women taking estrogen therapy alone showed that estrogen was associated with an increased risk for stroke (paralysis) and cancer of the uterus, but not for heart attack or breast cancer.

How does a doctor decide about providing HRT?

The decision about hormone therapy, therefore, is a very individual decision in which the patient and doctor must take into account the inherent risks and benefits of the treatment along with each woman's own medical history.

What are the other treatment options for menopause?

The other treatment options include: (i) Oral Contraceptive Pills (ii) Vaginal cream for local application (iii) Anti-depressants.

Does the risk of heart disease increase after menopause?

Yes, the risk of heart disease increases because of the decline in estrogen levels.

Why are post menopausal women susceptible to fracture?

Post menopausal women susceptible to fracture due to a condition known as osteoporosis due to weakening of bones. It is thus necessary to increase the intake of calcium in the diet as advised by a doctor.

What are the steps that can be taken at home to reduce the symptoms?

The following steps may be taken at home to reduce the symptoms:

Hot flashes: (i) Dress in light clothing (ii) Avoid hot beverages

Vaginal dryness: Try using vaginal lubricants like KY jelly

At least 8 hours sleep and relaxation.

Include a variety of fruits, vegetables and whole grains in the diet.

Do a light exercise for at least 30 minutes everyday.

Some women report that vitamin E supplements can provide relief from mild hot flashes. Is this true ?

Scientific studies are lacking to prove the effectiveness of vitamin E in relieving symptoms of menopause. Taking a dosage greater than 400 international units (IU) of vitamin E may not be safe, since some studies have suggested that greater dosages may be associated with cardiovascular disease risk

Youth and HIV/AIDS

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In India people in the age group of 15-29 years comprise almost 25 percent of the country’s population; however, they account for 31 percent of AIDS burden. This clearly indicates that young people are at high risk of contracting HIV infection.

What Makes Youth Vulnerable?

Physiologically, young people are more vulnerable to STIs than adults; girls more than boys. Gender imbalances, societal norms and economic dependence contribute to this risk.

Lack of access to correct information (almost 73 percent of young people have misconceptions about modes of HIV transmission), tendency to experiment and an environment which makes discussing issues around sexuality taboo adds to their vulnerability.

Vulnerable groups

Most young people become sexually active during adolescence. In the absence of right guidance and information at this stage they are more likely to have multi-partner unprotected sex with high risk behaviour groups. Particularly vulnerable are impoverished, unemployed, under-employed, mobile/migrant youth, adolescents in sex work, young injecting drug users and street children as they are faced with high risk behaviour in their everyday life. They are also less likely to have information on the risks of contracting HIV and means of protecting themselves from the infection. Such youth may face repeated risk of HIV infection through sexual exposure due to coercion or other compulsions.

Young women are biologically more vulnerable to HIV infection than young men – a situation aggravated by their lack of access to information on HIV and even lesser power to exercise control over their sexual lives. Early marriage also poses special risks to young people, particularly women. This is especially relevant for India, where almost 50 percent girls are married off by the time they are 18 years of age.

General Educational Objectives for 2009 Courses

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General Educational Objectives for
2009 Courses

Upon completion of an IAS-USA course, participants will be able to:

Design antiretroviral strategies that consider current data on:

- When to initiate therapy Managing initial treatment failure and complicated failure and the use of newly approved drugs and assays Mechanisms of antiretroviral resistance and nuances in interpreting resistance test results Drug-drug interactions among antiretrovirals and between other medications The status of investigational antiretroviral drugs and classes
- Difficult metabolic complications and toxicities of HIV and its therapies
Identify and discuss new issues in HIV pathogenesis, as they impact clinical treatment strategies
Formulate appropriate management strategies for HIV coinfection, such as hepatitis B and C viruses and sexually transmitted infections
Describe the incidence, diagnosis, and management of common manifestations of HIV disease, such as oral and dermatologic, as well as opportunistic infections and diseases
Formulate appropriate management strategies for special populations such as substance users
Discuss topics in HIV clinical treatment specific to the needs of the regional HIV specialists