TACKLING SIBLING RIVALRY

What is sibling rivalry?

Sibling rivalry is the jealousy, competition and fighting between brothers and sisters. It is a concern for almost all parents of two or more kids. Problems often start right after the birth of the second child. Sibling rivalry usually continues throughout childhood and can be very frustrating and stressful to parents. There are lots of things parents can do to help their kids get along better and work through conflicts in positive ways. Read on for tips and resources to help you keep the peace at your house.

What’s the up-side of having more than one child?
Most likely your kids’ relationship will eventually develop into a close one. Working things out with siblings gives your children a chance to develop important skills like cooperating and being able to see another person’s point of view.

What causes sibling rivalry?
There are many factors that contribute to sibling rivalry:
o Each child is competing to define who they are as an individual. As they discover who they are, they try to find their own talents, activities, and interests. They want to show that they are separate from their siblings.
o Children feel they are getting unequal amounts of your attention, discipline, and responsiveness.
o Children may feel their relationship with their parents is threatened by the arrival of a new baby.
o Your children’s developmental stages will affect how mature they are and how well they can share your attention and get along with one another.
o Children who are hungry, bored or tired are more likely to become frustrated and start fights.
o Children may not know positive ways to get attention from or start playful activities with a brother or sister, so they pick fights instead.
o Family dynamics play a role. For example, one child may remind a parent of a relative who was particularly difficult, and this may subconsciously influence how the parent treats that child.
o Children often fight more in families where parents think aggression and fighting between siblings is normal and an acceptable way to resolve conflicts.
o Not having time to share regular, enjoyable family time together (like family meals) can increase the chances of children engaging in conflict.
o Stress in the parents' lives can decrease the amount of time and attention parents can give the children and increase sibling rivalry.
o Stress in your children’s lives can shorten their fuses, and decrease their ability to tolerate frustration, leading to more conflict.
o How parents treat their kids and react to conflict can make a big difference in how well siblings get along.

How can you help your kids get along better?

The basics:
o Don’t play favorites. This one is a “biggie”.
o Try not to compare your children to one another. For example, don't say things like, "Your brother gets good grades in math—why can't you?"
o Let each child be who they are. Don’t try to pigeonhole or label them.
o Enjoy each of your children’s individual talents and successes.
o Set your kids up to cooperate rather than compete. For example, have them race the clock to pick up toys, instead of racing each other.
o Pay attention to the time of day or other patterns in when conflicts usually occur. Are conflicts more likely right before naps or bedtime or maybe when children are hungry before meals? Perhaps a change in the routine, an earlier meal or snack, or a well-planned quiet activity when the kids are at loose ends could help avert your kids’ conflicts.
o Teach your kids positive ways to get attention from each other. Show them how to approach another child and ask them to play, and to share their belongings and toys.
o Being fair is very important, but it is not the same as being equal. Older and younger children may have different privileges due to their age, but if children understand that this inequality is because one child is older or has more responsibilities, they will see this as fair. Even if you did try to treat your children equally, there will still be times when they feel as if they’re not getting a fair share of attention, discipline, or responsiveness from you. Expect this and be prepared to explain the decisions you have made. Reassure your kids that you do your best to meet each of their unique needs.
o Plan family activities that are fun for everyone. If your kids have good experiences together, it acts as a buffer when they come into conflict. It’s easier to work it out with someone you share warm memories with.
o Make sure each child has enough time and space of their own. Kids need chances to do their own thing, play with their own friends without their sibling, and to have their space and property protected.
Be there for each child:
o Set aside “alone time” for each child, if possible. Each parent should try to spend some one-on-one with each kid on a regular basis. Try to get in at least a few minutes each day. It’s amazing how much even 10 minutes of uninterrupted one-on-one time can mean to your child.
o When you are alone with each child, you may want to ask them once in a while what are some of the positive things their brother or sister does that they really like and what are some of the things they do that might bother them or make them mad. This will help you keep tabs on their relationships, and also remind you that they probably do have some positive feelings for each other!
o Listen—really listen—to how your children feel about what’s going on in the family. They may not be so demanding if they know you at least care how they feel.
o Celebrate your children’s differences.
o Let each child know they are special in their own way.
Resolving conflicts:
o Research shows that you should pay attention to your kids’ conflicts (so that no one gets hurt, and you can notice abuse if it occurs). Try to see if your children can work out their own conflicts, but remember that younger children will probably need you to intervene and help structure the problem-solving. Try not to take sides and favor one child over the other. Get them settled and calm first, then ask questions about what happened before dispensing discipline.
o Help your kids develop the skills to work out their conflicts on their own. Teach them how to compromise, respect one another, divide things fairly, etc. If you give them the tools, eventually they will have the confidence that they can work it out themselves.
o Don’t yell or lecture. It won’t help.
o It doesn’t matter “who started it,” because it takes two to make a quarrel. Hold children equally responsible when ground rules get broken.
o In a conflict, give your kids a chance to express their feelings about each other. Don’t try to talk them out of their feelings. Help your kids find words for their feelings. Show them how to talk about their feelings, without yelling, name-calling, or violence.
o Encourage win-win negotiations, where each side gains something.
o Give your kids reminders and advance warnings (for example, counting to three). When they start picking on each other, help them remember to state their feelings to each other. Help them solve the problem themselves. You can offer suggestions, but let them decide what are the best options.
o If you are constantly angry at your kids, no wonder they are angry at each other! Anger feeds on itself. Learn to manage your anger, so you can teach your children how to manage theirs.
o Teach conflict resolution skills during calm times.
o Model good conflict resolution skills for your kids when interacting with them and with other family members.
When to intervene:
o Dangerous fights need to be stopped immediately. Separate the children. When they have calmed down, talk about what happened and make it very clear that no violence is ever allowed.
o If your children are physically violent with each other on a regular basis, and/or one child is always the victim, is frightened of the brother/sister, and doesn’t fight back, you are dealing withsibling abuse. You should seek immediate professional help and guidance.
Involve your children in setting ground rules. Ground rules, with clear and consistent consequences for breaking them, can help prevent many squabbles. Here are a few ideas:
o In a conflict, no hurting (hitting, kicking, pinching, etc.) is ever allowed.
o No name-calling, yelling, or tattling is allowed.
o If the kids fight over a toy, the toy goes into time-out.
o Any child who demands to be first, will go last.
o No making fun of a child who is being punished, or you will also be punished.
o No fighting in the car, or you will pull over and stop until all is calm again.
o If arguing over who gets first choice of bedtime stories or favorite seats in the car is a problem, assign your kids certain days of the week to be the one to make these choices
o If borrowing is a problem, have the child who borrows something from a brother or sister put up collateral—a possession that will be returned only when the borrowed item is returned.

What are family meetings, and how can they help with sibling rivalry?

If you have older children, call a family meeting every once in a while. A family meeting is a meeting for all family members to work together to make family decisions. . Parents, children, and any others who live in the home and have a stake in decisions affecting the daily life of the family should take part. Choose a time that works for everyone. Establish a set of rules (for example., no yelling or name-calling, everyone gets a turn) and allow everyone to have a say, even if members don’t agree.

The purpose of the family meeting is to recognize that everyone's opinion makes a difference. The meeting allows the family to share their opinions, seek understanding, and find resolutions to problems. Family meetings help to build cooperation and responsibility, and make anger and rebellion less likely. Also, it is a time to share love, develop unity, and to build trust and self-esteem. The social skills and attitudes that children develop within the family circle are the skills and attitudes they will carry with them the rest of their lives

Sample Agenda for Family Meetings: (1)
o Discuss family issues, concerns, interests, and positive events of past week.
o Determine priority issue(s).
o Clarify the issue to be discussed.
o Generate possible solutions.
o Determine the most effective solutions.
o Make plans to implement the solution.
o Plan one fun activity for the coming week.

Ground Rules for Family Meetings: (2)
o Everyone gets a chance to talk
o One person talks at a time and does not get interrupted
o Okay to say what you feel
o No one has to talk
o Everyone has to listen
o No one puts anyone else down

Depression in old age.

“You don’t count your age, you make your age count” – Unknown.

The above saying is quite true, but rarely seen put into practice. Most old people instead of enjoying their present prefer spending it worrying and fretting over their past and future! Couple this with the deaths of near and dear ones, loss of an active social life, a feeling of isolation as near and dear ones get busy with their own lives and old age depression is imminent.

Is depression natural in old age?
Depression is not natural in old age even though it is common in adults above 65 years of age. Most often, environmental factors such as the death of near ones and isolation, along with physical factors such as a chronic illness or certain painful conditions tend to induce depression in old people.

Depression during old age is more likely to affect women than men. People above 65, who have a medical history of heart problems, stroke, joint ailments and chronically painful medical conditions, face a higher risk of suffering from depression during their old age. Even those who have a history of drug and alcohol abuse are more prone to depression than other non- addicts.
But can depression be harmful in old age?
Depression can be harmful during any age, but more so during the old age, as it is coupled with isolation and lack of social activity. More over depression can also lead to various mental and physical problems if ignored in old people, which in most cases goes unnoticed as dementia. And since depression has a direct link to suicide it is a major concern, be it in old people or teenagers.

How can one identify the symptoms of depression in old people?

Symptoms of depression in old people, as mentioned earlier can be easily missed due to doctors and family members confusing them with other age related problems, however following is a list of symptoms that you should keep your eye out for, if your parent or any other old person in your house has been behaving a little differently than their regular selves.

• Gloominess
• Loss of interest in social interaction and hobbies, if any
• Loss of appetite and resultant weight loss
• Alcohol or prescription drugs abuse
• Disturbances in sleep patterns, like sleeping through the day and staying awake at night, sleeping for unusually long hours, staying awake for long hours at a stretch
• Lack of interest in various other things such as personal hygiene and self-medication
• Forgetfulness
• Suicidal thoughts
• Often feeling anxious and nervous

How to prevent depression and ensure a happy senior citizen?

Depression is a treatable condition, and can be treated with the help of medications and therapy. However some prescription medications to tend to cause depression, so be sure to consult your doctor before administering the medicines.

Following are a few ways in which you can help prevent or get an old person out of depression:
Schedule regular social activities for them: The first thing that depression does to any person is that, it robs them of their self worth and esteem. This directly results in a reduction in that individual’s social interaction, and as man is a social animal, a reduction in social interaction leads to isolation and depression.

To counter this, you need to schedule social activities for them, mostly with people belonging to their age group. Activities such as attending Prayer meets, laughter groups, daily morning walks, family functions etc can ensure that their social interactions stay intact and they don’t feel unwanted or useless.

A proper Diet is a must: Having a proper diet can help in preventing depression. Most times depression is caused in old age due to chronic illnesses and medicines taken to counter these diseases and conditions. Having a well-balanced and nutritional diet will ensure that they get their required nutrition, their body’s immune system will be strengthened and they will have fewer ailments and lesser medications too.

Ensure that they complete their treatment: Depression in the elderly which is being treated with the help of medicines needs to be followed up i.e. you need to ensure that medicines are being taken on time and the doctor’s orders are being followed by them to ensure a speedy and healthy recovery.

Get them a furry friend: Pets are good way to combat depression, as has been proven in many studies on the same. A pet will not only give them constant company but will also take their mind off their negative thoughts, furthering a positive feeling in them, thereby reducing their depression considerably!

Get them to Exercise: A sedentary lifestyle not only promotes an unhealthy body but also an unhealthy mind. As one ages the body becomes more and more stiff and due to the weakening of the immune system, it falls prey to various diseases. An hour of light exercises in old age is enough to take care of niggles such as stiff joints and mobility, plus it also promotes a sense of well-being and helps them to socialize in the process, if they are going to a gym.

And as Maurice Chevalier says, “Old age isn't so bad when you consider the alternative”. Don’t let the elderly lose their golden years to depression; help them enjoy their old age.

Ways to reduce exam stress in children?

When exam season comes children get busy preparing for their subjects, stress and anxiety levels are at their peak points. Exam stress in children is usually caused by certain imaginary fears and often the lack of confidence. A child who is not well prepared has all the reasons to get stressed. However, exams are a cause of stress even for the best prepared ones. Now a day’s parents too feel exam stress along with their children. Here are some ways which will help you in coping exam stress in your child.

Causes of Exam Stress in Children

• Worry: Most of the children always get stressed because they worry about their subjects. "How to prepare for all subjects in such less time?", this thought bother them always.

• Performance anxiety: It’s a reason for stress for almost all children, as parents pressurize them to get full marks every time and write good paper without leaving any questions.

• To Prove Themselves: Some children are constantly forced to get the top grade. Another reason for children to be stressed is when parents expect young one to be like their elder sibling if he is a good scorer.

• Negative Thoughts: Before exams approaches, most of children's minds are filled with all negative thoughts. They often feel that they won’t be able to give their best even if they are prepared.

Examination stress is a universal phenomenon which is not only common in students but their parents too. Parents today want their children to have successful careers and comfortable lives. They tend to put so much pressure on their children that he/she cannot give their best even if they try hard to.

Parents Pressurize Kids For

• Parents tend to compare their child with others and always nag them to be like them.

• Children study hard under pressure to get things like games, computer etc.

• To maintain reputation in social circle, there are some parents who fall in the social trap of making their kids achievement a showcase.

• Intense competition: Every parent wants their child to be the best. Increasing competition drives parents to pressurize their children to always do the best.

For well being of their child’s future, parents become very passionate about their exam. Most of the parents struggled hard to reach where they are and hence they always want their children to be best in putting efforts during exams. They forget to realize that every person is born with some special skills and talent; they make whole examination as big issue.
Ways to Coping with Exam Stress in Children
Coping with exam stress is very important for child’s mental health. Once they understand the way to handle it they won’t be stressed and worried about it. Down are the ways to cope up with exam stress in your child.

• Start Early
Children often get more stressed when there preparation are not done properly. Make sure your child doesn’t start studying all subjects at the last moment. This is surely not going to help but confuse him and make him less confident. Explain them how studying before hand is going to help them to gain confidence and perform better in exams. Cultivate the habit to study everyday apart from doing the regular homework.

• Help to Schedule

Help your child to schedule his studies. You can prepare a time table chart and put it up in his room or near the study table. This will make him feel relaxed and not overloaded. He can study each subject according to chart.

• Don’t pressurize
Try and avoid pressurizing your child. Putting more pressure is going to hamper his efforts of studying. All the efforts which your child is taking can go in vain if you force him unnecessarily. He will study for the sake of studying but may not be able to answer all questions in the paper during writing exam. Also, don’t threaten him to get full marks, as it is going to scare him more.

• Sit With Them
Sit next to him and enquire about his studies. Ask them if they he/she any doubts or difficulties which you can help him to understand. Make him feel that everything is going to be fine and he doesn't have to worry about examinations. Some children are weak in certain subject who needs attention; make sure you dedicate time for it and solve their difficulties.

• Be Supportive and Encouraging
Exam period can be stressful for your child. If your child is a poor scorer, don’t shout and get frustrated by the way he is studying. Being supportive and encouraging is very necessary on behalf of parents. Shouting, getting angry is only going to make situation worse, he might not be able to concentrate and lose confidence. Some children fall sick during examination period. Such children need to be treated with good care. If he doesn’t overcome exam fear, you can take him to child counselor.

• Motivation
Explain your child benefits of having good marks and also how they can be useful in their future. Explain him its alright if they score badly but instill the confidence in them that they can always work hard to achieve the best. Motivation is the best tool for handling exam stress.

• Create a Healthy Environment
The environment in which your child studies makes a lot of difference. Make sure you maintain the sound of television while he/she is studying. Don’t allow siblings to go near the child, as they can create distraction. Make sure that his room has enough bright light. You can keep a bottle of water in his room as this will save his time and will help to maintain his concentration.

• Breaks
Make sure your child takes enough breaks in middle. Studying at stretch can be really boring and strenuous. Taking breaks will make him fresh and be focused when he starts studying again.

• Good Food
Give them energy boosting food during exams period. Include eggs, vegetables and lot of fruits and dry fruits.

• Relax
Teach your child to relax and stay calm. You can allow him to go out for half an hour or allow him to watch his favorite serial. You can also teach them to mediate for few minutes as it helps in improving concentration.

• Sleep
Make sure your child gets good sleep. Remember that it is their stressful time, if they don’t get enough sleep they might be cranky and moody. A child must at least for 8 to 10 hours so that he will feel fresh and relaxed.

Exam stress can be handled efficiently by parents with positive attitude. Not all children are the same and hence everyone cannot be at the top. Every parent has to understand their own child, by being supportive and encouraging you can make children feel that examinations are not dreadful. Remember if your child is not good at academics, he may be good at sports, music, arts etc. Encourage them in things which interests them, Sachin Tendulkar, AR Rahman were not good at studies and look where they are today!!

Thank you for your wishes on Doctors Day.

My dear patients.
All your good wishes for the Doctors Day are acknowledged.
Thank you so very much for all your love and faith in my treatment.
I will strive more harder in future and do my best to take care of you and your loved ones in illness.

Dr. Shashank Dhuri
Medical Director
Sapna Maternity and General Hospital
(Service to Mankind is our Religion)

HIV Awareness 1: What Is HIV?

What is HIV?
HIV stands for Human Immunodeficiency Virus. HIV is the virus that causes AIDS.

Your immune system is your body's defense system. While many viruses can be controlled by the immune system, HIV targets and infects the same immune system cells that are supposed to protect us from illnesses. These are a type of white blood cell called CD4 cells (sometimes called T-cells).

HIV takes over CD4 cells and turns them into factories that produce thousands of copies of the virus. As the virus makes copies, it damages or kills the CD4 cells, weakening the immune system.

What is AIDS?
AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is the most advanced stage of HIV infection.

HIV causes AIDS by attacking CD4 cells, which the immune system uses to protect the body from disease. When the immune system loses too many CD4 cells, you are less able to fight off infection and can develop serious, often deadly, infections. These are called opportunistic infections (OIs).

When someone dies of AIDS, it is usually OIs or other long-term effects of HIV that cause death. AIDS refers to the weakened state of the body’s immune system that can no longer stop OIs from developing and becoming so deadly.

What is the Difference Between HIV and AIDS?
You don't have AIDS as soon as you are infected with HIV. You can be HIV+ for many years with no signs of disease, or only mild-to-moderate symptoms. But without treatment, HIV will eventually wear down the immune system in most people to the point that they have low numbers of CD4 cells and develop more serious OIs.
The Centers for Disease Control and Prevention (CDC) identifies someone as having AIDS if he or she is HIV+ and has one or both of these conditions:
At least one AIDS-defining opportunistic infection (see list of OIs in our info sheet called AIDS Defining Conditions)
A CD4 cell count of 200 cells or less (a normal CD4 count is about 600 to 1,500)

How Do I Know if I Have HIV?
Most people cannot tell that they have been exposed or infected. Symptoms of HIV infection may show up within two to four weeks of exposure to HIV, and can include fever, swollen glands, muscle aches, or rash. Some people do not notice the symptoms because the symptoms are mild, or people think they have a cold or the flu. The only way to know for sure if you are infected is to take an HIV test.


Do I Need to Get Tested for HIV?
The CDC estimates that about 21% of HIV+ people do not know their HIV status. Many of these people look and feel healthy and do not think they are at risk. But the truth is that anyone of any age, gender, race, sexual orientation, or social or economic class can become infected. It is your actions (or the actions taken against you), that put you at risk.
Answer the following questions:
Have you ever had vaginal, anal, or oral sex without a condom?
Have you ever shared needles or syringes to inject drugs (including steroids or hormones)?
Are you uncertain of your partner’s status or is your partner HIV+?
Are you pregnant or considering becoming pregnant?
Have you ever had a sexually transmitted disease (STD)?
Do you have hepatitis C (HCV)?
If you answered yes to any of these questions, you should definitely get an HIV test.

Why Should I Get Tested?
If you test HIV+ there are effective medications to help you stay well. But you cannot get the health care and treatment you need if you do not know your HIV status. Being unaware of your status also means that you could pass HIV to others without knowing it.

For women who plan to become pregnant, testing is especially important. If a woman is infected with HIV, medical care and certain drugs given during pregnancy can lower the chance of passing HIV to her baby.

If you test HIV-negative you can take steps to stay that way. You can also avoid unnecessary worrying.

What Tests are Available?
If you have been infected, your immune system will make antibodies against HIV. The most common HIV tests look for these antibodies. The HIV antibody test (called ELISA or EIA) is one of the most reliable medical tests. It can be done on blood, mouth swab, or urine.

Before a positive antibody test result is reported, it is confirmed by another test called a Western Blot. According to the CDC, the combined accuracy of the antibody test plus the Western Blot is greater than 99 percent.

Some antibody tests take a few days for results, but rapid tests are also available that can give results in about 20 minutes. All positive rapid tests must be followed by the Western Blot to confirm the results. Results of this confirmatory test can take a few days to a few weeks.

A negative antibody test result means your body has not developed antibodies and you are probably not infected. To get truly accurate results, it's necessary to wait three to six months after your last possible exposure to the virus before being tested. That is because the immune system can take anywhere from two to eight weeks to make antibodies. If you are tested in this "window period," you may get an unclear result or a false negative.

There is another type of test called the RNA test, which detects the virus directly. The RNA test can give results very early in HIV infection, but is more costly and used less often than antibody tests.

Where Can I Get Tested?
You can get tested at your health care provider’s office, a clinic, the local health department facilities, or at a hospital.

It is a good idea to get tested at a place that provides counseling. Counselors can answer questions about high-risk behavior and suggest ways you can protect yourself and others in the future. People who test HIV+ can receive support and referrals to health care and other services. The counselor can help you through the whole testing process – from start to finish.

Is There a Vaccine to Prevent HIV Infection?
There is currently no vaccine available. The best way to prevent HIV is to use sterile needles and practice safer sex .


Information provided on this blog is for educational purposes only. It is designed to support, not replace, personal medical care and should never be used as a substitute for personal medical attention, diagnosis, or hands-on treatment. I recommend all medical decisions be made in consultation with your personal health care provider.

HIV Awareness 2: HIV Transmission

How HIV Spreads?
Many people still misunderstand how HIV is passed from one person to another. Knowing the basics helps you avoid getting the virus if you are HIV-negative, and avoid giving it to someone else if you are HIV+.

HIV is spread through the following body fluids:
Blood (including menstrual blood)
Semen and other male sexual fluids ("pre-cum")
Vaginal fluids
Breast milk
HIV is not spread through these body fluids:
Sweat
Tears
Saliva (spit)
The spread of HIV can be prevented! There are ways to avoid, or at least reduce, contact with body fluids that spread HIV. This info sheet explains how.

Methods of Transmission
In the past, HIV was spread by transfusion with blood products, such as whole blood or the "factor" used by hemophiliacs. Many people were infected this way. The blood supply is now much more strictly tested and controlled. The odds of being infected from receiving blood or blood factor in the US are very low.

You cannot get HIV from donating blood – a new, sterile (clean) needle is used for each donation.

Some people, primarily healthcare workers, are infected through needle sticks with infected blood, or through other medical accidents. This is a very small percentage of overall infections.

Today, the most common ways HIV is passed from one person to another are:
Re-using and sharing needles for injecting drugs (including steroids or hormones)
Unprotected/unsafe sex (no condoms or other barrier devices)
Mother-to-child (during pregnancy, birth, or breast-feeding)

Re-using and Sharing Needles
Many HIV infections occur when people share needles to inject heroin, methamphetamine, steroids, hormones, or other drugs. This risk may be reduced by cleaning needles with a bleach solution before re-using them. However, some experts question how effective this method really is in reducing transmission.

It is best to use fresh needles each time. This eliminates any risk of infection. Many cities offer free needle exchange programs.

Tattoos or body piercings should always be done by a licensed professional whose equipment is autoclaved, not just "sterilized" with alcohol.

Unprotected/Unsafe Sex
Every sexual act (oral, anal, or vaginal) that involves sexual fluids of some kind has at least some risk. Barriers, such as condoms (male and female), dental dams (thin squares of latex), and latex gloves help reduce risk substantially.

Unsafe sex (sex without condoms or barriers) puts you and your partner at risk for HIV or other sexually transmitted diseases (STDs).

Safer sex (sex using condoms or other barriers correctly and consistently) protects you and your partner.

Which common sexual activities are most likely to cause HIV transmission when safer sex isn't used?
Listed from most to least risky:
Receptive anal sex ("bottoming"): This remains the most risky activity, due to the likelihood of small tears in the rectum allowing semen to have direct contact with the bloodstream. But penetrative anal sex ("topping") can result in HIV transmission, too.
Vaginal intercourse: This puts both partners at risk, but HIV is transmitted from men to women much more easily than from women to men.
Oral sex: This can be risky for the person performing it, particularly if he or she swallows semen, vaginal fluids, or menstrual fluids.
Sharing sex toys without sterilizing them: This can allow HIV to be transmitted from one partner to the next one who uses the toy.
Rimming (licking the anus): This is very unlikely to result in HIV infection.
Mutual masturbation (hand jobs) and fisting (using a hand to penetrate the anus or vagina): These are relatively low risk, as long as your hand has no open cuts or sores.
Sexual assault or rape can result in infection if the attacker is HIV+. The risk increases when rape involves anal penetration, force, and/or multiple attackers. Some forced sexual acts involving wounds can place a victim at very high risk.

In major cities, PEP (post-exposure prophylaxis) is often offered to victims of sexual assault or rape. This month-long treatment with HIV drugs reduces the likelihood of HIV infection substantially. It is currently only used on a regular basis for victims of sexual assault and for healthcare workers who have been exposed to HIV on the job. PEP must be started as quickly as possible, always within 72 hours of the exposure.

Mother-to-Child Transmission
HIV+ mothers can pass the virus to their babies while pregnant, during birth, or by breastfeeding. Medical care and HIV drugs given during pregnancy can almost eliminate the risk of a baby getting HIV from its mother. HIV+ mothers should not breastfeed their babies.

Rare Types of Transmission
There are a few isolated cases of people becoming infected from using a razor that had just been used by an HIV+ person, or from using a toothbrush immediately after the toothbrush was used by someone who was HIV+, or in other unexpected ways. To be safe, always avoid direct contact with blood and sexual fluids in any context.

Don't worry too much about rare cases. For instance, there is one documented case of transmission from deep or "French" kissing – in two people who had terrible dental problems. However, the odds of getting HIV from kissing, even when one person is HIV+, are less than the odds of being struck by lightning.

How HIV is, and is not, Transmitted
HIV cannot be transmitted except when certain body fluids are exchanged. You can greatly reduce the risk of transmission by:
Avoiding contact with sexual fluids by always practicing safer sex
Abstaining from sex unless you and your partner are both HIV-negative and in a long-term, monogamous relationship
Not injecting drugs, or if you do, always using new or clean needles
Finding out your HIV status if you are planning to get pregnant and working with a knowledgeable health care provider and obstetrician if you are HIV+
If you protect yourself in these ways, you do not need to be afraid of getting or passing HIV by casual contact. Remember, HIV is not transmitted by:
Hugs
Dancing
Sharing food or drinks
Using a shower, bath, or bed used by an HIV+ person
Kissing (between people with no significant dental problems)
Sharing exercise equipment
Bug bites


Information provided on this blog is for educational purposes only. It is designed to support, not replace, personal medical care and should never be used as a substitute for personal medical attention, diagnosis, or hands-on treatment. I recommend all medical decisions be made in consultation with your personal health care provider.

HIV Awareness 3: Safer Sex

Sexual Harm Reduction
Most people know that serious, even life-threatening, infections like HIV, hepatitis and other sexually-transmitted diseases (STDs) can be passed from one person to another through sex. One approach to lowering this risk is called "harm reduction." If you do not want to abstain from sex (not have sex at all), harm reduction offers options to make sexual activity safer.

Safer sex isn’t only for the prevention of new HIV infections. It’s important for people who are HIV+, too. A couple where both partners are HIV+ can use safer sex to prevent co-infection with other STDs that can weaken the immune system. Safer sex can also reduce the possibility of getting reinfected (also called superinfected) with a strain of HIV that is resistant to the drug regimen you are taking.

Since every sexual act that involves sexual fluids or blood has at least some risk, safer sex means using barriers every time. Barriers include condoms (male and female), dental dams (thin squares of latex), and even latex gloves. Barriers help reduce risk substantially.

Even though it is the safest thing to do, some couples do not always use barriers. If this is the case, you can still practice some kind of harm reduction.

Practicing Safer Sex
Sometimes the place to start in safer sex is to identify the riskiest thing you do and then think about how you could make that activity less risky. The following are some safer sex tips, starting with the most risky activities and moving to less risky activities:

Penetrative Sex (sex in anus or vagina)
Penetrative sex is considered the highest-risk activity. For both vaginal and anal sex, use latex condoms and water- or silicone-based lubricant (lube) to prevent the condom from breaking. (Lube also helps condoms feel better.) Do not use oil-based lubes like Vaseline, Crisco, or baby oil with condoms because they increase the risk of the condom breaking.

If you’re not going to use condoms, try to reduce the friction by using a lot of lube to help prevent small cuts or tears in the vagina, rectum, or penis. Silicone-based lube will last longer than water-based lube. Because you’re not using a condom, oil-based lube can also be used. Avoid getting semen in the body by having the man pull out before cumming.

Oral Sex
A number of studies have demonstrated a low but definite level of risk associated with oral sex. To make it safer, use latex condoms for oral sex on a man. If you perform oral sex without a condom, finish up with your hand, or spit semen out and rinse with a dental wash rather than swallowing.

Dental dams are squares made from latex. Put some water- or silicone-based lube on one side of the dental dam or a condom that has been cut open. Then stretch the dam or condom over the vagina or anus with the lubed side facing away from your mouth. This gives you a thin barrier between your mouth and the vagina or anus. (NOTE: Some people use plastic food wrap instead of dental dams or cut-open condoms. Plastic food wrap may prevent the transmission of herpes infections, but there is no proof that it can prevent the transmission of HIV.)

If you don’t use a barrier, avoid getting precum, semen, or vaginal fluids in your mouth. Avoid vaginal oral sex during menstruation to prevent contact with blood. Bad oral hygiene (bleeding gums, ulcers, gum disease) can make oral sex much riskier. Use a mint instead of brushing your teeth before sex.

Fisting, Handballing, or Fingering
Paper cuts and other openings in the skin can make your hands vulnerable to infection. Wearing latex gloves keeps you protected during hand-vagina or hand-anus sex. Adding water- or silicone-based lube to the outside of the gloves will increase your partner’s pleasure.

Other safer sex tips: Limit the time and frequency of penetrations. Try non-penetrative sex for a change. For example, consider mutual masturbation. Also get medical attention for any infections or health problems in the genital area.

Thinking it Through
Try and change ways of thinking that make it difficult for you to practice safer sex. The things you think influence how you act.

Thought: "We slipped once and forgot to use a condom, so it's too late now."
New idea: It's never too late. Yes, even one exposure can be dangerous, but it's not as dangerous as a hundred exposures! If you slipped once, it's time to get back on the wagon.

Thought: "Safer sex is such a drag. It's no fun."
New idea: Here's a great chance to spice up your sex life. Why not take one of the workshops offered on "Eroticizing Safer Sex?" How about getting a book, video, or DVD about hot safer sex?

Thought: "I can't feel anything through condoms!"
New idea: Time to change brands! Getting free condoms at the health office or buying them at a drugstore may be cheap, but you're probably not getting the best around. Try some of the variety packs offered by mail-order sex supply catalogs or hit the "adult love" stores in your area for a better selection. The best condoms are thin but tough and transmit heat and sensation well.

Thought: "My partner absolutely refuses to use a condom."
New idea: How comfortable are you with someone who is willing to put your life at risk? This sounds like a serious issue, and it's probably not the only one in your relationship. Have you considered individual or couple's counseling?

Thought: "I can't suggest to my girl/guy that we get an HIV test. We've been together so long that s/he would take it as an insult."
New idea: How about presenting it as an act of love? "You know, I really love you. We've been together for awhile, but we never got tested for HIV. I hate the thought that I could be putting you at risk, because I couldn't stand to hurt you. Why don't we go get tested together for our peace of mind?"

Sometimes the safest thing you can do in sex is keep a clear head. Sex when you are drunk or under the influence of drugs may be most likely to be unsafe.


Information provided on this blog is for educational purposes only. It is designed to support, not replace, personal medical care and should never be used as a substitute for personal medical attention, diagnosis, or hands-on treatment. I recommend all medical decisions be made in consultation with your personal health care provider.

HIV Awareness 4: Oral Sex, What's The Real Risk

The chances of HIV being transmitted from an HIV+ person to an HIV-negative person depends on the type of contact. HIV is most easily transmitted through unprotected (no condoms) anal sex, unprotected vaginal sex, and sharing injection drug equipment.

Oral sex has been shown to be less risky than these activities, but it is not risk-free. It is also possible to get other sexually-transmitted diseases (STDs), such as syphilis, herpes, and gonorrhea through oral sex.

Studies on the Risks of Oral Sex
Even though oral sex is a lower-risk activity, people have reportedly become infected with HIV in this way. A number of studies have tried to determine the exact level of risk of oral sex, but it can be difficult to get accurate information from study participants. Since oral sex is not the only sexual activity for most people, it is also difficult to single out oral sex as the definite way HIV was transmitted. Because of these issues, different studies have reported different levels of risk ranging from less than 1% to about 8%.

The take home message of these studies is that oral sex carries a small but real risk.

Tips for Safer Oral Sex
Oral sex is more risky if you or your partner have an untreated STD, bad oral hygiene (bleeding gums, ulcers, gum disease), or take ejaculate (cum) in the mouth. There are things you can do to reduce the risk associated with oral sex:
Don’t have oral sex if you or your partner have mouth sores (such as oral herpes lesions).
Look at your partner’s genitals for lesions (cuts or scrapes).
If you find something, don’t believe your partner if he or she tells you it was caused by the heat, the weather, or clothes. You should avoid any contact with the area until a health care worker has examined it.
Don’t floss, brush your teeth, or do anything that would create abrasions or cuts in your mouth before performing oral sex. Use mouthwash or a breath mint instead
Avoid swallowing pre-cum, semen, or vaginal fluids.
Use latex condoms for oral sex on a man (try the unlubricated, flavored ones).
If you perform oral sex without a condom, finish up with your hand, or spit semen out and rinse with a mouthwash rather than swallowing.
Use a dental dam or cut-open condom for oral sex on a woman or for rimming (licking the anus).
Dental dams are squares made from latex. Put some water-based lube on one side of the dental dam or a condom that has been cut open. Then stretch the dam or condom over the vagina or anus with the lubed side facing down. This gives you a thin barrier between your mouth and the vagina or anus. (Some people use plastic food wrap as a barrier. While plastic wrap has been shown to prevent the transmission of herpes infections, there is no proof that it will prevent the transmission of HIV.)
Avoid vaginal oral sex during menstruation to prevent contact with blood.
Take care of your mouth. The likelihood of oral HIV transmission increases if you have bleeding gums, ulcers, cuts, sores, or infections in the mouth.
Find alternatives
Try massage or mutual masturbation.
Use a vibrator (use a condom when sharing).
Avoid vigorous, prolonged oral sex ("deep-throating").
Avoid mouth or throat trauma caused by a large number of partners in a short period of time.

Taking Care of Yourself
Any type of sexual activity with an infected person carries a risk of HIV transmission. While the risk of becoming infected through unprotected oral sex is lower than that of unprotected anal or vaginal sex, bad oral hygiene and taking cum in your mouth makes oral sex more risky.

If you or your partner is HIV+, you should decide what steps to take to make all types of sex as safe as possible. If you would like to discuss these issues, see a sex educator or health care provider at your local AIDS service organization or treatment center.


Information provided on this blog is for educational purposes only. It is designed to support, not replace, personal medical care and should never be used as a substitute for personal medical attention, diagnosis, or hands-on treatment. I recommend all medical decisions be made in consultation with your personal health care provider.

HIV Awareness 5: Women and HIV

A Look at the Numbers
Over 25 years have passed since the first diagnosis of AIDS in INDIA. While there were a handful of women among the first cases, AIDS was thought to primarily affect gay men. However, as the years passed, women have emerged as another group hard hit by the AIDS epidemic. Even though more men than women still have HIV in the INDIA, women are catching up. In some countries, HIV+ women outnumber HIV+ men.

The proportion of HIV/AIDS cases among women has more than tripled from 8 percent in 1985 to an alarming 27 percent in 2008. That means that about one in four INDIAN living with HIV are women. HIV has also become the third most-deadly disease for women, behind only cancer and heart disease.

HIV affects both younger and older women. In fact, an increase in HIV diagnoses has been seen in older women (50 and older).

Heterosexual sex is the most common mode of transmission among women in the INDIA. Nearly three quarters of HIV+ women contracted the virus through sex with an HIV+ man. Heterosexual sex is also the main source of HIV transmission for women in many other countries in Africa, South America, and Western Europe. Sharing HIV-contaminated syringes for injecting drugs is another frequent mode of transmission.


Is HIV Different for Men and Women?
Until recent years, little research had been done on women and HIV. While many questions remain unanswered, available information shows that HIV affects men and women differently in some ways:
When women are first diagnosed, they tend to have lower viral loads (amount of HIV in the blood) compared to men who are newly diagnosed
Women generally have a faster disease progression, and lower CD4 cell counts, than men with equivalent viral loads
Women are more likely than men to develop bacterial pneumonia
Women have higher rates of herpes infections than men
Women get thrush (a yeast infection) in their throats more often than men
Men are eight times more likely than women to develop Kaposi's sarcoma or KS (a cancer-like disease caused by a herpes virus)
Women tend to be diagnosed with HIV later in their disease than men and fewer women than men are getting HIV treatment. This can have a negative impact on women’s health. Women may postpone medical care and treatment due to a number of barriers including:
Limited access to health care due to lack of insurance and/or transportation
Unstable housing
Fear of partner (domestic) violence
Other responsibilities such as child care or caring for a sick partner
The stigma associated with HIV
Active substance abuse
Depression
Lack of financial resources and/or social supports
Mistrust of the medical establishment


Treatment in HIV+ Women: Efficacy, Side Effects, and Drug Interactions
HIV treatment studies ( clinical trials) have traditionally included very small numbers of women. As a result, most information on the effectiveness and safety of HIV drugs comes from research done in men. This under-representation of women in trials has only recently begun to change.

The good news is that the existing research has found little difference in terms of the effectiveness of HIV treatment. HIV+ women who begin treatment as recommended have been found to do as well as HIV+ men. Although treatment seems to work as well in women, in some cases, the side effects may differ:

Rashes: Researchers say that HIV+ women are more likely than men to experience skin rashes from HIV medications.

Liver problems: Women are more likely to experience liver problems as a medication side effect. In fact, women with a CD4 count above 250 are warned against starting a regimen with Viramune (nevirapine) because of the risk of dangerous liver problems.

Body shape changes: Some studies have found that HIV+ women experience different types of body shape changes than men. Women may experience more fat gain in their breasts and waists.

Weak bones: It is known that women in general are at increased risk of developing osteoporosis (weak bones) after menopause, but studies have also shown that HIV infection increases a person’s risk of losing bone mineral density. This places both HIV+ men and women at increased risk of osteoporosis. However, HIV+ women’s risk for bone weakness is three times higher than HIV+ men’s.

Gender differences in side effects may be due to interactions between HIV therapy and female hormones. It may also be the result of women's smaller physical size. Standard doses of drugs are usually based upon research done predominantly in men.

This means women, who generally weigh less than men, may get higher amounts of drugs in their bodies than is needed to be effective. This does not mean that HIV+ women should take lower doses of their medications. Until and unless there is proof that women can be treated with lower doses of HIV medications, women should take their medications at the doses currently recommended for all adults living with HIV.

HIV+ women do need to be careful about drug interactions. Certain HIV drugs can affect the levels of other drugs in the body. For example, several HIV drugs can impact the levels of birth control pills.

HIV+ women should be treated by health care providers with experience treating women with HIV. Tell your health care providers about all other medical conditions you have and medications you are taking. If you are experiencing side effects from HIV drugs, be sure to ask your health care provider for help.


Gynecological Issues in HIV+ Women
Certain gynecological conditions are more common, more serious and/or more difficult to treat in HIV+ women than HIV-negative women:
Some vaginal infections (including yeast infections)
Bacterial vaginosis
Common sexually transmitted diseases (STDs), such as gonorrhea, Chlamydia, and trichomoniasis
Genital herpes
Pelvic inflammatory disease (PID)
Although little conclusive research is available on HIV and menstruation, many HIV+ women report abnormal menstrual periods. Some have excessive bleeding while others stop menstruating altogether.

Human papillomavirus (HPV) is an STD that causes 99% of cervical cancer and can also cause genital warts. HIV+ women are more likely to be infected with HPV than HIV-negative women. HIV+ women, especially women with advanced HIV disease, are also more likely to develop dysplasia as a result of HPV.

Dysplasia is a pre-cancerous condition. It is often more severe and difficult to treat in HIV+ women than in HIV-negative women. Untreated dysplasia can lead to cervical cancer, a life-threatening illness.

It is very important for HIV+ women to have regular Pap smears. A Pap smear is a screening test your health care provider does to check for changes in the cervix. An abnormal Pap smear can indicate inflammation, infection, dysplasia, or cancer.

HIV+ women are 10 times more likely to have abnormal Pap smears than HIV-negative women. These abnormal Paps are usually associated with low CD4 cell counts and HPV. Girls and women who are 12 - 26 years old should talk to their health care providers about whether they should get the HPV vaccine.

The Centers for Disease Control (CDC) recommends that:
HIV+ women have a complete gynecological examination, including a Pap smear, when they are first diagnosed and when they first seek prenatal care
HIV+ women have another Pap six months later
If both tests are negative, yearly screening is recommended
Women who have symptomatic HIV infection or who have had dysplasia in the past should receive a Pap smear every six months

Pregnancy and HIV
With the advances in HIV care and treatment, many HIV+ women are living longer, healthier lives. As they think about the future, some of these women are deciding to have the babies they always wanted. HIV+ women who want to be come pregnant should discuss their plans with a health care provider who is very experienced in treating women with HIV.

The good news is that the advances in HIV treatment have also brought down the rate of mother-to-child HIV transmission significantly. If the mother takes appropriate medical precautions, the rate of transmission can be reduced from 25 percent to below 2 percent. In addition, studies have shown that being pregnant will not make HIV progress faster in the mother. For more information on pregnancy and HIV, click here.

In Conclusion
The numbers of HIV women are growing. This means that all women should be aware of the risk and be tested if there is any possible reason to think they may have been exposed to HIV. If you test negative, you can take steps to stay that way.

If you test positive, you can take step to prevent passing the virus on to others, including during pregnancy. And while there is no cure yet, many HIV+ women are living longer and stronger lives thanks to effective care and treatment.

More research is needed to determine how HIV progresses in women and how HIV drugs affect women’s bodies. However, it does seem that the HIV drugs can benefit women as much as men. By taking advantage of good health care and treatment in a timely fashion, you increase your chances of living a longer and healthier life for you and your loved ones.


Information provided on this blog is for educational purposes only. It is designed to support, not replace, personal medical care and should never be used as a substitute for personal medical attention, diagnosis, or hands-on treatment. I recommend all medical decisions be made in consultation with your personal health care provider.

HIV Awareness 6: Pregnancy and HIV

The Good News
Due to advances in HIV care and treatment, many women living with HIV (HIV+) are living longer, healthier lives. As HIV+ women think about their futures, some are deciding to have the babies they always wanted.

The good news is that advances in HIV treatment have also greatly lowered the chances that a mother will pass HIV on to her baby (known as the rate of mother-to-child HIV transmission). If the mother takes appropriate medical precautions, the chances of transmission can go down from about 1 in 4 (when not taking any HIV drugs) to less than 1 in 50 (when taking proper HIV drugs). In addition, studies have shown that being pregnant will not make HIV progress faster in the mother.

Before You Get Pregnant
It is important to plan carefully before getting pregnant:
Discuss your plans with your HIV health care provider to make sure you are on the right treatment plan for your own health and to reduce the risk of transmitting HIV to your baby (more about this in the next sections)
Find an obstetrician (OB) or midwife who is familiar with HIV care. He or she can explain your options for getting pregnant with as little risk to your partner as possible.
Ask your HIV health care provider and your OB or midwife to talk with each other and coordinate to make sure you receive appropriate care before and during your pregnancy
Get screened for sexually transmitted diseases (STDs) and hepatitis B or C
Give up smoking, drinking, and drugs. All of these can be bad for your health and the health of your baby.
Start taking pregnancy vitamins ("prenatal" vitamins) that contain folic acid and calcium while you are trying to become pregnant. This can reduce the rates of some birth defects.
If friends and family do not support your decision to have a child, put together a support network of people who are caring, non-judgmental, and well educated about HIV and pregnancy. Your network can include of medical providers, counselors, and other HIV+ women who are considering pregnancy or have had children.

The Pregnancy Guidelines
A group of experts on pregnancy in HIV+ women has developed guidelines that provide information about appropriate care and treatment for HIV+ women who are, or may become, pregnant.
As a first step, the pregnancy guidelines recommend a thorough check up, including a number of blood tests, to find out about your health and the status of your HIV infection. A resistance test (see TWP sheet on resistance for info about this test) should be included if you:
Are starting HIV drugs
Are taking HIV drugs and have a detectable viral load (500 – 1,000 copies or more)
The results of a resistance test can help you and your health care provider choose the best drugs to take.

HIV drugs can reduce the risk of transmitting HIV from mother to baby. For this reason, HIV drugs are recommended for all pregnant women regardless of CD4 count and viral load. Even if the mother does not need HIV treatment for her own health, it is important for her to take HIV drugs to lower the risk of mother-to-child transmission. The drugs need to be taken just as they are prescribed to have the best chance of working. (See TWP sheet on adherence for more info.)

There are certain HIV drugs that should be avoided or used with caution because of possible side effects in the mother or the developing baby. Some examples are Sustiva (efavirenz), Atripla (which contains Sustiva), Viread (tenofovir), and the combinations of Videx (didanosine, ddI) and Zerit (stavudine, d4T) or Zerit and Retrovir (zidovudine or AZT). Viramune (nevirapine) should not be started in HIV+ women with CD4 cell counts over 250.

Discuss the risks and benefits of the HIV drugs with your health care provider so that you can decide which treatments are best for you and your baby. Your health care provider can call the National Perinatal HIV Hotline at 1-888-448-8765 for free, expert advice on all aspects of caring for HIV+ pregnant women.

HIV Drugs and Pregnancy
Deciding when to start treatment depends on your own health and when you find out you are pregnant. The pregnancy guidelines make the following recommendations:

For HIV+ Women Not Taking HIV Drugs
When HIV treatment is needed for the health of the woman: she should receive a combination of HIV drugs based on treatment guidelines for non-pregnant adults. Retrovir should be used as one of the drugs in the combination if possible. HIV treatment should start as soon as possible, including in the first trimester (three months) of pregnancy.
When HIV treatment is not needed for the health of the woman: she should also receive HIV treatment to prevent mother-to-child transmission. Retrovir should be used and, in most cases, combined with other HIV drugs. Women in the first trimester may consider waiting to start the HIV drugs until after the first 10–12 weeks of pregnancy. After the birth of the baby, the mother should be evaluated to see if she needs to continue HIV treatment for her own health.
In both of the above cases, HIV drug treatment should continue during labor and delivery. At that time, the Retrovir should be switched to intravenous (IV) administration. After delivery, the baby should receive liquid Retrovir for six weeks.

For HIV+ Women Already Taking HIV Drugs
Continue current HIV drugs if they are working well to control the virus and have not been show to harm the pregnant mother or developing baby (see list above) . If the drugs are not working, switch to a more effective combination. Retrovir should be used as one of the drugs in the combination if possible. The drugs should be continued during labor and delivery, during which time IV Retrovir should be given to the mother. After delivery, the baby should receive liquid Retrovir for six weeks.

For HIV+ Pregnant Women in Labor Who Have Not Taken HIV Drugs
A woman in labor who has not taken HIV drugs can still reduce the risk of infecting her baby by using HIV drugs during labor and delivery and to treat the baby for a short time after birth. The guidelines recommend the following options:
IV Retrovir for the mother during labor and liquid Retrovir: for the baby for six weeks after birth.
Single-dose Viramune for the mother at the beginning of labor and IV Retrovir during labor. Consideration should be given to adding Epivir (lamivudine or 3TC) during labor and continuing Retrovir and Epivir for three to seven days after delivery. This may reduce the possibility of the mother’s virus becoming resistant to Viramune. The baby receives single-dose Viramune plus liquid Retrovir for six weeks.
IV Retrovir given to the mother during labor and liquid Retrovir plus additional drugs for the baby after delivery. However, it is unclear if this strategy further reduces the risk of transmission.
After the baby is born, it is recommended that the mother be evaluated to determine whether HIV treatment is recommended for her.

For Babies Born to HIV+ Women Who Have Not Taken HIV Drugs Before or During Labor
The baby can still receive treatment to reduce the risk of transmission. The guidelines recommend the following options:
Liquid Retrovir given to the baby for six weeks, started as soon as possible after birth.
Liquid Retrovir, plus additional drugs, given to the baby. However, it is unclear if this strategy further reduces the risk of transmission.
After the baby is born, it is recommended that the mother be evaluated to determine whether HIV treatment is recommended for her.

Invasive Tests, Procedures and Delivery
There are a number of invasive prenatal tests, such as amniocentesis, chorionic villus sampling (CVS), and percutaneous umbilical blood sampling, that may increase the risk of HIV transmission to the baby. Talk to your health care provider if you need these tests. Certain procedures during delivery, such as invasive monitoring and forceps- or vacuum-assisted delivery, should be avoided if possible.

There are 2 types of delivery: cesarean (C-section) and vaginal delivery:

C-section
Elective or planned C-sections are done before labor begins and before the mother’s "water" (membranes that surround the baby) breaks. This reduces the baby’s contact with the mother’s blood and may reduce the risk of transmission in certain cases. Since C-sections require surgery, they carry some risks. Women who have C-sections are more likely to get infections than those who give birth vaginally. C-sections are recommended for HIV+ pregnant women who:
Have an unknown viral load
Have a viral load greater than 1,000 copies at 36 weeks of pregnancy
Vaginal delivery
For a woman on combination HIV treatment with a low viral load (less than 1,000), a C-section is not likely to further reduce her already low risk of transmitting HIV.

The decision of which type of delivery is most appropriate should be discussed with your health care provider early in your pregnancy.

After the Baby is Born
During the first six weeks, the baby will need to take Retrovir (zidovudine) (and possibly other HIV drugs). A blood test called a complete blood count (CBC) should be performed on the baby before he or she starts the medication. The baby will also need to take medication to prevent pneumonia after finishing Retrovir, unless there is adequate information to confirm that the infant does not have HIV. Taking these medications doesn’t mean the baby is sick; it is just a precaution to decrease the chances of getting HIV and other illnesses.

The baby will receive several HIV tests to determine if he or she is infected. An HIV DNA PCR or and HIV RNA PCR virologic assay should be used. Virologic assays test for the HIV virus, rather than HIV antibodies. HIV antibody tests, which are commonly used to determine HIV infection in adults, should not be used in newborns since babies carry their mother’s antibodies for 12 to 18 months.

HIV virologic testing should be done at 14 to 21 days, one to two months, and four to six months. A positive HIV virologic test should be confirmed with a second test. Two positive HIV virologic tests establish a diagnosis of HIV infection. HIV may be ruled out with two or more negative tests with one at one month and another at four months or later, when the mother is not breast-feeding. Many experts confirm HIV-negative status with an HIV antibody test when the baby is 12 to 18 months old.

Since a baby can be infected with HIV through breast milk, it is important not to breast feed if you have other options. You can still have a strong bond with your child even if you bottle feed.


In Conclusion
Deciding to have a baby is a big step for any woman, but for an HIV+ woman, it is even more complicated. Talk to your HIV health care provider and OB or midwife before you start trying to get pregnant. If you plan ahead, there are many things you can do to protect your health and the health of your new baby.



Information provided on this blog is for educational purposes only. It is designed to support, not replace, personal medical care and should never be used as a substitute for personal medical attention, diagnosis, or hands-on treatment. I recommend all medical decisions be made in consultation with your personal health care provider.

HIV Awareness 7: HIV Disclosure

Preparing for Disclosure
Disclosure means telling someone that you are HIV+. Sharing your HIV status can help with the stresses of living with HIV. But who to tell and how to tell can be complicated and difficult decisions.

There is no one best way to tell someone, just as there is no sure way to know how they will react to your news or whom they may choose to tell. To prepare, it may help to ask yourself a few questions:
Who do I want to tell and why do I want them to know?
How much am I ready to share or are they ready to hear?
How will disclosing my HIV status affect me and how will it affect the people I tell?
Consider where you want the disclosure to take place. It could be at home, at a friend’s house, or in a health care setting so that support is readily available. The important thing is that you choose a place that is comfortable for you.

How Disclosure Affects You and Others
Disclosing your HIV status can be stressful. While you may receive love and support from some of the people you tell, others may not be as accepting. Try to find someone that can support you through this difficult process. If you have not told any family yet, turn to your health care provider, social worker, counselor, or AIDS service organization (ASO).

Disclosing your HIV status will also have an effect on the people you tell. People will react differently to the news. Your friends and family may immediately embrace you and accept your diagnosis. Others may react negatively or need some time to process what you have told them.

Just like you, people you tell will need support too. Try to leave them brochures or books about HIV that they can look at later. Give them the addresses of websites that provide information (a good government site is at http://aids.gov/hiv-aids-basics/). Also let them know who else is aware of your status, so that they can go to each other for support.

Who Needs to Know
You do not have to tell everyone that you are HIV+. However, it is important that you tell your current and past sexual partners and anyone you have shared needles with to inject drugs. This way they can be tested and seek medical attention if required. If you are afraid or embarrassed to tell them yourself, the health department in your area can notify your sexual or needle-sharing partners without even using your name.

You also need to tell your health care providers to ensure you receive appropriate care. Your health care provider may ask how you were infected to determine if are at risk for other diseases, such as hepatitis C for injection drug users and other sexually transmitted diseases (STDs) for women infected through sex.

Disclosure and Relationships
Serious Relationship
If you are in a serious relationship, telling your partner is one of the first things you will probably think about. Many turn to their partners for comfort and support. However, some people may worry that they will lose their partner’s love when they disclose. It’s normal to feel nervous, embarrassed, or even fearful of your partner’s reaction.

Since you and your partner most likely have a sexually relationship, you do need to let them know that they may have been exposed to HIV and should get tested. Also, you now need to think about practicing safer sex.

Disclosing your HIV status can put a strain on the best of relationships. It's important for you to think about when and how to disclose, but keeping the information to yourself for too long is probably not a good idea. It may be helpful to getting some professional counseling.

Be aware that women are at risk for violence when disclosing their HIV status. If you are worried that your partner may become violent, think about having the discussion with another person you trust present: a therapist, an HIV advocate, or a health care professional.

Dating
Women who are dating have to face the question of disclosure with each new relationship. Some women prefer to get the issue out into the open immediately. Others prefer to wait and see if the relationship is going to develop beyond casual dating.

Although many people know about safer sex and how HIV is transmitted, fear and stigma are still a reality. Your HIV status will prevent some from wanting to see you, while others will not be put off by the information.

In most cases, sharing your HIV status is a personal choice, but in the case of sexual relationships, it can be a legal requirement. It is best if you disclose your status prior to having sex with anyone new.

Non disclosure of HIV status in a sexual relationship can lead to criminal charges whether or not your partner becomes infected with HIV. In most states, the law requires that you disclose your HIV status before knowingly exposing or transmitting HIV to someone else. Penalties vary from state to state. In many states, you can be found guilty of a felony for not telling a sexual partner you are HIV+ before having intimate contact.

Who Does Not Need to Know
People with disabilities, including HIV, are protected from job discrimination under the Americans with Disabilities Act (ADA). However, you should think carefully before disclosing your HIV status at work. You do not have to tell your employer that you are HIV+. If you haven't had any HIV-related symptoms or illnesses and are not on medications that are affecting your job performance, there's probably no need tell.

If HIV or your medications are interfering with your ability to work, it may be a good idea to privately disclose your status to your boss. You can ask for an adjustment in your schedule or workload so that you can continue to do your job. Because the law regards an HIV+ person as a disabled person, your employer is required to reasonably accommodate your needs if you are otherwise qualified to perform the essential duties of the job.

If you are planning to disclose at work for employee or benefits purposes (like reasonable accommodation, insurance, disability, or medical leave), contact an employee benefits counselor or an HIV or legal advocate before disclosing.

Who You May Want to Tell
Women often choose to disclose their status to close friends and family members who they trust. For many, telling those closest to them provides them with both emotional and practical support.

Some people decide to become more public and use their stories to advocate for others with the government or in the media. Others may disclose for educational purposes to neighbors, community and religious groups, schools, other HIV+ people, or healthcare providers. Many women find a sense of purpose and increased self-esteem by telling their story.

You may want to consider how much of your story you are ready to tell. Many people will ask you how you became infected. If you decide not to share that information, have a reply ready such as, “does it really matter?” or simply state that you are not ready to talk about that.

Disclosing to Children
For moms considering telling their children, it is important to ask yourself why you want to tell them:
Will they be angry if you keep a secret?
Do they suspect something?
Are you sick?
Children can react to the news of HIV in the family in many different ways. Older kids may be upset that you kept a secret from them. Younger children may just want to go back to their toys. Partial truths can be helpful when telling children. You may decide only to tell them as much as you consider appropriate for their age.

Do not forget that kids need support too. If you can, give them the name of another adult they can talk to, perhaps an aunt or grandparent.

Taking Care of Yourself
There are many reasons to tell people that you have HIV:
Getting support from family and friends, at the time of diagnosis and in the future
Fostering a sense of closeness with friends and loved ones
Reducing the risk of HIV transmission to others
Not having to live with the stress of keeping HIV a secret
Ensuring that you get the most appropriate care and treatment from your health care providers
Disclosing can feel empowering
In close relationships, studies show that living with a secret, such as HIV, can be more emotionally harmful than the rejection that could result from disclosure. Many women who have kept a secret for a long time feel a sense of relief after telling.

However, telling other people that you have HIV can also have downsides. So think carefully about who you tell. Remember that once you disclose, you cannot take it back. ASOs and health care clinics can offer resources to guide women through the disclosure process.


Information provided on this blog is for educational purposes only. It is designed to support, not replace, personal medical care and should never be used as a substitute for personal medical attention, diagnosis, or hands-on treatment. I recommend all medical decisions be made in consultation with your personal health care provider.

HIV Awareness 8: Considering HIV Treatment

Are you Ready?
Treatment with HIV drugs can improve quality of life and help people living with HIV (HIV+ people) stay healthier longer. But starting treatment is a big decision. In order to get the most benefit from HIV drugs, they must be used just the way they are prescribed. Taking your treatment correctly is as important as which drugs you and your doctor choose. So before you get started, make sure you are ready to commit to taking your HIV drugs the right way, every day for your own health! This takes a combination of the right health care provider, enough knowledge about HIV, and a positive attitude.

The Right Health Care Provider
You and your health care provider are a team working together to make the best treatment decisions for you. Ask yourself a few questions: Do I have confidence in my provider? Can I be totally honest with him or her? Is he or she available when I have questions? Does he or she take my concerns seriously? If so, great!

If not, try to make changes. Write down the questions you’d like to ask your health care provider before you go to visits. It’s important to answer your provider’s questions with the truth, not with what you think the she or he wants to hear. If that still doesn’t work, it may be time to find another provider.

It is also wise to have a health care provider who is an HIV specialist. Health care providers who devote most of their time to HIV are best able to manage this complicated condition.

Knowledge about HIV


The Basics
HIV is a virus that infects and destroys CD4 cells. CD4 cells are part of the body’s immune system. The immune system protects the body from invaders. When the immune system loses too many CD4 cells, it becomes weak and is unable to fight off germs. At this point, you are at risk of getting AIDS-related opportunistic infections (OIs) that can cause serious illness or death.

HIV Treatments
Scientists have developed drugs that block HIV from reproducing (multiplying). These drugs are grouped into classes. Each class of drugs works to stop HIV at a certain point in its life cycle. So far there are five classes of drugs:
Entry inhibitors (includes fusion inhibitors and CCR5 antagonists)
Integrase inhibitors
Nucleoside/nucleotide reverse transcriptase inhibitors (“nukes” or NRTIs)
Non-nucleoside reverse transcriptase inhibitors (“non-nukes” or NNRTIs)
Protease inhibitors (PIs)
HIV drugs are always used in combination to attack the virus at different points in its life cycle. This usually means using drugs from at least two classes. Combining HIV drugs is the best way to reduce the amount of HIV in your blood ( viral load).

Baseline Blood Tests
Before you start HIV treatment, your health care provider should have you take a number of blood tests. These are your baseline tests. Future test results will be compared to your baseline results to check how you are doing and how your treatment is working.
CD4 cell (T-cell) count: The CD4 count checks the strength of your immune system. After you start HIV treatment, you should see your CD4 count go up. Your CD4 count should be checked every 3-4 months, if possible.
Viral load test: The viral load test measures the amount of HIV in your blood. After you start HIV treatment, you should see your viral load go down. Your viral load should be checked about a month after you start or change HIV drugs. After that, it should be checked every 3-4 months.
Resistance test: The resistance test helps determine which drugs are likely to work for you. Experts recommend that everyone should get a resistance test before starting or changing HIV treatments, even if you do not plan to start HIV treatment for a while.
Other tests to check your overall health: These include complete blood count (CBC), chemistry screen, lipid profile, and glucose. Your health care provider should talk with you about how often these tests need to be done.

Treatment Goals
To get your viral load as low as possible for as long as possible
To preserve or improve the health of your immune system by increasing your CD4 cells
To improve your quality of life and reduce illness and death

Treatment Guidelines
The government has put together a list of guidelines to help people decide when to start treatment:
Anyone with a CD4 count less than 350 should start HIV treatment
If you are in one or more of the following situations, you should also start HIV treatment, no matter what your CD4 count:
You have or had symptoms of AIDS (such as OIs)
You are a pregnant woman
You have HIV-related kidney disease
You need treatment for hepatitis B (HBV)
HIV treatment is recommended to be started in anyone with a CD4 cell count between 350 and 500
Your readiness to start and stick to treatment is also an important factor. Talk to your health care provider to make sure you understand the importance of adherence (see below) and to make a plan to address any barriers to adherence before starting.
Some experts feel that it is a good idea to start treatment earlier – with a CD4 count above 350 and no symptoms. There are risks and benefits to doing this.

Benefits of Starting Early:
Maintaining a higher CD4 cell count
Preventing further damage to the immune system
Decreasing risk for HIV and non-HIV health problems
Reducing your risk of transmitting HIV to others
Risks of Starting Early:
Experiencing drug-related side effects, including possible long-term side effects not yet known
Developing drug resistance (see below), which can reduce future treatment options
Having to be on treatment for a longer time

Adherence
Whenever you start treatment, you need to take your drugs on schedule. This is called adherence. In order to get the maximum benefit from HIV therapy, good adherence is required. This is because HIV drugs need to be kept at a certain level in your body to fight the virus. If the drug level falls, HIV may have a chance to fight back. Skipping doses, not taking the drugs on time, and not following food requirements can all cause your drugs to be less effective or to stop working altogether.

Resistance
After starting HIV drugs, you should see your viral load decrease and your CD4 cells increase. Over time, however, some people see their viral load increase, even though they are still taking HIV drugs.

When a drug is no longer able to fight HIV effectively, we say that HIV has become "resistant" to that drug. If you develop resistance, you will likely have to change some of the drugs in your regimen. If your viral load goes up while you are still taking HIV drugs, your health care provider should offer you a resistance test to find out which drugs aren’t working and to help choose ones that will. For some people with resistance to many HIV drugs, it may be difficult to find a new combination.

The best way to fight resistance is to be adherent to your drug regimen.

A Positive Attitude
If you decide the time is right to start treatment, have a good attitude going in. Believe that:
Starting treatment is the right decision for you
The HIV medications will help you fight the virus
You can take your medications the right way
Whatever decision you make, don’t go it alone. Put together a support system including your health care provider, nurses, social workers, and case managers. You may want to join a support group of other HIV+ people. Family and friends can help too.
The more you think and talk about your decision, the better the outcome. Whatever you decide to do, keep going to your health care provider for regular check ups and blood work.


Information provided on this blog is for educational purposes only. It is designed to support, not replace, personal medical care and should never be used as a substitute for personal medical attention, diagnosis, or hands-on treatment. I recommend all medical decisions be made in consultation with your personal health care provider.

Did You Just Test HIV +ve

Getting an HIV diagnosis can feel like the worst news in the world. It is common to feel anger, fear, confusion, shock, grief, depression, or other painful emotions. Even after you’ve known for some time and think you are coming to terms with the news, it may suddenly hit you all over again.

Normal Feelings
The first step in getting through this difficult period is to understand that these feelings are normal responses to your diagnosis. Ignoring them will not make them go away. Allow yourself to feel what is inside you. It is OK to cry if you feel like it.

Anger, fear, and sadness are emotions that most people with serious illnesses experience. You are facing the possibility of getting sick or dying. You may be scared that you will not see the children in your life grow up. Or maybe you are afraid that you will not achieve your life goals. In the beginning, it may seem that testing positive is a death sentence, but this is not true. There is life after a positive test. In fact, many people living with HIV (HIV+) people lead full and healthy lives.

You may also feel that you are now damaged in some way and that no one will want to love you because you are HIV+. Or you may blame yourself for getting HIV and ask yourself, "how could I have let this happen to me?" Try not to be too hard on yourself. Guilt and shame can be destructive. Forgive yourself if you need to. If possible, try to have some compassion for yourself. You have just gotten bad news and must face changes and challenges ahead. Remember that you are still the same person you always were, as capable of giving and receiving love as ever.

Get Help and Support
Being diagnosed with HIV presents many challenges. Building a support network can help you learn to cope. Take your time and don't feel that you have to tell everyone right away. Don’t let fear of being judged cause you to isolate yourself and not talk to anyone. If it is hard to tell family and friends at first, you may want to turn to HIV organizations.

Many newly-diagnosed people want to speak with others in the same situation. This can decrease isolation and help overcome stigma. Don’t settle for, "You’re lucky, this is the best time to get diagnosed" or "You should have known better." There are many AIDS service organizations (ASOs) that offer support and information to HIV+ people. You will be able to find non-judgmental people to talk with there.

Joining a support group and talking about your feelings in a safe space may reduce fears and concerns.

Finding networks or others who are in similar situations might also help you not to feel so alone. Be sure to check out The Well Project’s blog, “A Girl Like Me” (http://www.girllikeme.org) for first-hand accounts of HIV+ women from different parts of the world and how they each have dealt with their HIV diagnosis.

It's Better To Know
As upsetting as testing positive can be, you are better off knowing. Once you know you are HIV+, you can take charge of your health and have the best chance to slow or prevent disease progression. Getting informed about HIV and its treatment will help you make the best of your situation.

An important factor in getting good care and treatment is to find the right health care provider. Look for a health care provider who specializes in treating HIV. Studies have shown that an HIV+ person whose health care provider treats many HIV+ people lives longer than a person whose health care provider treats a few HIV+ people.

Even though there is no cure for HIV disease, there are many treatments that help keep HIV under control. There are now over 25 HIV drugs available. Much has been learned about how to use these drugs more easily and effectively, and with fewer side effects. The use of HIV drugs is allowing many HIV+ people to live long and healthy lives.

You will need to get information and work with your health care provider to decide what treatments are best for you. There are many good places to get information including ASOs, hotlines, and websites. But be careful about the information you're getting. Check it out with your health care provider or other reliable sources to make sure it's accurate. Remember, there are no "miracle" cures. If it sounds too good to be true, it probably isn’t true.

Learning that you are HIV+ may make you feel you have lost control over your life. Try not to let this rush you into making decisions when you are still coming to terms with your diagnosis. Remember, you are in charge of your own health care. You can decide which treatments you use and when to use them. Take your time and learn about your options. Unless you're very ill and need to make treatment decisions quickly, you have time to think things through.

HIV and Women
You are not alone. About one million people in INDIA are HIV+, and approximately one in four people newly diagnosed with HIV are women. There are many HIV+ women who can provide information, support, and advice.

Keeping to yourself can make the process of moving forward after the diagnosis more difficult. It is a good idea to reach out to people, but if anyone threatens you with violence or is abusive, it's time to step away from them. Take yourself and any children you have to a safe place and talk with someone you trust. You need a positive environment and supportive people in your life.

Also be careful not to put your family's welfare ahead of your own. When you take care of yourself, you are doing something good for yourself and your family. You owe it to them to make sure you are as healthy as you can be.

Make a New Start
Being diagnosed with HIV is life changing. Once you know you are HIV+, you can never not know it. Learn to see yourself as a person living with HIV, not a victim. You can do this by getting informed, taking charge of your health care, and learning how to manage HIV. There are many resources to help you on this new path.

You may find that some of the priorities in your life now change. This can be a good thing. Facing a serious illness can prompt people to make their lives better. Many HIV+ people make favorable changes such as breaking bad habits like drinking too much or smoking. As serious as the diagnosis is, there is good reason to have hope that your life will be full and healthy. Don’t give up on yourself or your dreams.


Information provided on this blog is for educational purposes only. It is designed to support, not replace, personal medical care and should never be used as a substitute for personal medical attention, diagnosis, or hands-on treatment. I recommend all medical decisions be made in consultation with your personal health care provider.