PROGRAMS Copyright (c) 2008 COMMUNITY AIDS SERVICE PENANG (CASP) All rights reserved

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FREQUENTLY ASKED
QUESTION

1. What is HIV?
HIV is the human immunodeficiency virus that causes AIDS. HIV is a member of a group of viruses called retroviruses, it infects human cells and uses the energy and nutrients provided by those cells to grow and reproduce.

2. What is AIDS?
AIDS (acquired immunodeficiency syndrome) is a disease in which the body’s immune system breaks down and is unable to fight off certain infections, known as “opportunistic infections,” and other illness that take advantage of a weakened immune system.
• When a person is infected with HIV, the virus enters the body and lives and multiplies primarily in the white blood cells. These are the immune cells that normally protect us from the disease. The hallmark of HIV infection is the progressive loss of a specific type of immune cell called T-helper or CD4 cells. As the virus grows, it damages or kills these and other cells, weakening the immune system and leaving the individual vulnerable to various opportunistic infections and other illness, ranging from pneumonia to cancer.
• The U.S. Centers for Disease Control and Prevention (CDC) defines someone as having a clinical diagnosis of AIDS is they have tested positive for HIV and meet one or both of these conditions:
• They have experienced one or more AIDS-related infections or illnesses;
• The number of CD4 cells has reached or fallen below 200 per cubic millimeter of blood (a measurement known as CD4-cell count). In healthy individuals, the CD4 count normally ranges from 450 to 1,200/mm3.

3. How quickly do people infected with HIV develop AIDS?
In some people, the CD4 cell decline and opportunistic infections that signal AIDS develop soon after initial infection with HIV. Most people remain asymptomatic for 10 to 12 years, and a few much longer. As with most diseases, early medical care can help prolong a person’s life.

4. How many people are affected by HIV/AIDS?
The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that at the end of year 2005 there are over 45 million people living with HIV or AIDS worldwide. Most of them do not know they carry HIV and may be spreading the virus to others. In Malaysia, as at June 2005 over 67,438 people have HIV infection. In South & South East Asia, as many as 7.4 million adults and children have been infected and in Sub-Sahara there are 25.8 million people have been infected in the year 2005. AIDS has replaced malaria and tuberculosis as the world’s deadliest infectious disease among adults and is the fourth leading cause of death worldwide. Over 13 million children have been orphaned by the epidemic.

5. How is HIV transmitted?
A person who is HIV-infected carries the virus in certain body fluids, including blood, semen, vaginal secretions, and breast milk. The virus can be transmitted only if such HIV-infected fluids enter the bloodstream of another person. This kind of direct entry can occur (1) through the linings of the vagina, rectum, mouth, and the opening at the tip of the penis; (2) through intravenous injection with a syringe; or (3) through a break in the skin, such as a cut or sore. Usually, HIV is transmitted through:

• Unprotected sexual intercourse (either vaginal or anal) with someone who is HIV-infected. Women are at greater risk of HIV infection through vaginal sex than men, although the virus can also be transmitted from women to men. Anal sex (whether male-male or male-female) poses a high risk mainly to the receptive partner, because the lining of the anus and rectum are extremely thin and filled with small blood vessels that can be easily injured during intercourse.

• Unprotected oral sex with someone who is HIV-infected. There are far fewer cases of HIV transmission attributed to oral sex than to either vaginal or anal intercourse, but oral-genital contact poses a clear risk of HIV-infection, particularly when ejaculation occurs in the mouth. This risk is increased when either partner has cuts or sores, such as those caused by sexually transmitted diseases (STDs), which can allow the virus to enter the bloodstream.

• Sharing needles or syringes with someone who is HIV-infected. People who inject drug should never reuse or share syringes, water or drug preparation equipment. This includes needles or syringes used to inject illegal drugs such as heroin, as well as steroids. Other types of syringes, such as those used for body piercing and tattoos, can also carry HIV.

• Infection during pregnancy, childbirth, or breast-feeding (mother-to-infant transmission). Any women who is pregnant or considering becoming pregnant and thinks she may have been exposed to HIV – even if the exposure occurred years ago – should seek testing and counseling. Mother-to-infant transmission has been reduced in Malaysia where pregnant women are tested for HIV, and those positive are provided with drugs to prevent transmission and counseled not to breast-feed.

6. How is HIV not transmitted?
HIV is not an easy virus to pass from one person to another.
• It is not transmitted through food or air (for instance, by coughing or sneezing).
• There has never been a case where a person was infected by a household member, relative, co-worker, or friend through casual or everyday contact such as sharing eating utensils and bathroom facilities or hugging and kissing.
• You cannot get HIV from giving blood at a blood bank or other established blood collection center.
• Sweat, tears, vomit, faeces, and urine contain minimal amount of HIV. HIV is unable to infect through these fluids.
• Mosquito, fleas, and other insects do not transmit HIV.

7. Can you tell whether someone has HIV or AIDS?
You cannot tell by looking at someone whether he or she is infected with HIV or has AIDS. An infected person can appear completely healthy. Buy anyone infected with HIV can infect other people, even if no symptoms are present.

8. How can I know whether I’m HIV-infected?
Immediately after infection, some people may develop mild, temporary flu-like symptoms or persistent swollen glands. Even if you look and feel healthy, you may be infected. The only way to know your HIV status is to be tested for HIV antibodies – proteins the body produces in an effort to fight off infection. This usually requires a blood sample. If a person’s blood has HIV antibodies, that means the person is infected.

9. Should I get tested?
If you think you might have been exposed to HIV, you should get tested as soon as possible. Here’s why:

• Even in the early stages of infection, you can take concrete steps to protect your long-term health. If you don’t begin taking medications right away, regular check-ups with a doctor who has experience with HIV/AIDS will enable you to make the best decisions about how and when to begin treatment, without waiting until you get sick. Taking an active approach to managing HIV may give you many more years of healthy life than you would otherwise have.

• If you are HIV-positive, you will be able to take the necessary precautions to protect others from becoming infected.

• If you are HIV-positive and pregnant, you can take medications and other precautions to significantly reduce the risk of infecting your infant, including refraining from breast-feeding.

10. How can I get tested?
Most people get themselves tested at private clinics, laboratories, or at government hospitals. However, it is important to seek testing at a place that also provides counseling about HIV and AIDS. Counselors can answer questions about high-risk behavior and suggest ways you can protect yourself and others in the future. They can also help you understand the meaning of the test results and refer you to local AIDS-related resources. Though less readily available, there is also a viral load test than can reveal the presence of HIV in the blood within three to five days of initial exposure, as well as highly accurate saliva tests that are nearly equivalent to blood tests in determining HIV antibody status.

11. What is the Window Period?
Keep in mind that while most blood tests are able to detect HIV infection within four weeks of initial exposure, it can sometimes take as long as three to six months for antibodies to reach detectable levels. This is due to the Window Period. This is the period in which HIV is unable to be detected in the bloodstream of an individual. This is due to the required detectable levels of virus needed before the test is able to detect the presence of HIV. As mentioned, the Window Period is between three weeks to six months.

12. Where Can I Get Tested?
Free, Confidential HIV Testing at Public Hospitals
General Hospital Kuala Lumpur : (03) 2692 1044
Kuala Lumpur Hospital Emergency : (03) 2691 3814
Universiti Malaya Medical Centre : (03) 7956 4422
Tunku Puan Rahimah Hospital (Klang) : (03) 3372 3333

Confidential HIV Testing at Private Hospitals (for a fee)
Pantai Hospital (Bangsar) : (03) 2282 5077
Pantai Hospital (Cheras) : (03) 9132 2022
Subang Medical Centre : (03) 5634 1212
Pusat Rawatan Tawakal : (03) 4023 3599

13. How can I reduce my risk of becoming infected with HIV through sexual contact?
If you are sexually active, protect yourself from HIV infection by practicing safer sex. Whenever you have sex, use a condom. When used properly and consistently, condoms are extremely effective. But remember:
• Use only latex condom

• Use only water-based lubricants. Latex condoms are virtually useless when combined with oil or petroleum lubricants such as Vaseline or hand lotion.

• Use protection each and every time you have sex.

• If needed, consult a nurse, doctor, or health educator for guidance on the proper use of condoms.

14. How can I avoid acquiring HIV from a contaminated syringe?
If you are injecting drugs of any type, including steroids, do not share syringes or other injection equipment with anyone else. Disinfecting previously used needles and syringes with bleach can reduce the risk of HIV transmission. If you are planning to have any part of your body pierced or to get a tattoo, be sure to see a qualified professional who uses sterile equipment.

15. Is there a link between HIV and other STDs?
Having a sexually transmitted disease can increase your risk of acquiring and transmitting HIV. This is true whether you have open sores or breaks in the skin (as with syphilis, herpes and cancroids) or not (as with Chlamydia and gonorrhea). Where there are breaks in the skin, HIV can enter and exit the body more easily. Even when there are no breaks in the skin, STDs can cause biological changes that may make HIV transmission more likely. Studies show that HIV-infected individuals who are infected with another STD are three to five times more likely to contract or transmit the virus through sexual contact.

16. Are there other ways to avoid getting HIV through sex?
The male condom is the only widely available and inexpensive barrier against sexual transmission of HIV. Female condoms are fairly unpopular, still relatively expensive thus harder to obtain in Malaysia.
17. Are some people at greater risk of HIV infection than others? HIV does not discriminate. It is not who you are, but what you do that determines whether you can become infected with HIV. Although the statistics for Malaysia show that the majority of cases are drug users, this is by no means the real picture of the epidemic in this country. Worldwide, sexual intercourse is by far the most common mode of HIV transmission. There has been no reliable way to ascertain o assess the extent HIV has infected Malaysians through sexual transmission. Most Malaysians who are infected with HIV, DO NOT KNOW THAT THEY ARE INFECTED.

18. Are women especially vulnerable to HIV?
In western countries, women are four times more likely to contract HIV through vaginal sex with infected males than vice versa. This biological vulnerability is worsened by social and cultural factors that often undermine women’s ability to avoid sex with partners who are HIV-infected or to insist on condom use.

19. Are young people at significant risk of HIV infection?
Each year, half the numbers of new HIV cases worldwide are under the age of 25. Statistics show that by the age of 19, at least 10% of young people in this country have engaged in sexual intercourse, and more often than not, engaged in unsafe or unprotected sexual intercourse. Many young people also use drugs and alcohol, which can increase the likelihood that they will engage in high-risk sexual behavior.

20. Are there treatments for HIV/AIDS?
For many years, there were no effective treatments for HIV/AIDS. Today, people in Malaysia are able to obtain drugs to treat HIV infection and AIDS. Some of these are designed to treat the opportunistic infections and illnesses that affect people with HIV/AIDS. In addition, several types of drugs are used to prevent HIV itself from reproducing and destroying the body’s immune system:
• Reverse transcriptase inhibitors attack on HIV enzyme called reverse transcriptase. They include drugs (zidovudine (AZT), lamivudine (3TC), didanosine (ddl), stavudine (d4T), zalcitabine (ddC), efavirenz, nevirapine, abacavir, delavirdine.

• Protease inhibitors attack the HIV enzyme protease, eg. Include indinavir, ritonavir, saquinavir, amprenavir and nelfinavir.

Many HIV patients are taking several of these drugs in combination – a regime known as highly active antiretroviral therapy (HAART). When successful, such combination or “cocktail” therapy can reduce the level of HIV in the bloodstream to very low, even undetectable levels and sometimes enables the body’s CD4 immune cells to rebound to normal levels. Researches are working to develop new drugs known as fusion inhibitors and entry inhibitors that can prevent HIV from attaching to and infecting human immune cells. Efforts are also underway to identify new targets for anti-HIV medications and to discover ways of restoring the ability of damaged immune systems to defend against HIV and the many illnesses that affect HIV-infected individuals.

21. Is there a cure for HIV/AIDS?
There is still no cure for HIV/AIDS. And while new drugs are helping some people with HIV/AIDS live longer, healthier lives, there are many problems associated with them:
• Existing treatments do not work for some people with HIV/AIDS.
• Some of the anti-HIV drugs are highly toxic and can cause serious side effects, including anemia, renal stones, liver failure etc.

• HIV mutates constantly. In as many as 40% of people on HAART, HIV mutates into new viral strains that have become highly resistant to current drugs, and as many as 10% of those newly infected are acquiring drug-resistant strains of the virus.

• Because treatment regimes are unpleasant and complex, many patients occasionally miss doses of their medication. Failure to take anti-HIV drugs on schedule and in the prescribed dosage can encourage the development of new viral strains that are resistant to current HIV drugs.

• Even among those who do respond well to treatment, HAART does not eradicate HIV. The virus continues to replicate at low levels and often remains hidden in “reservoirs” in the body, such as the lymph nodes and brain.

Importantly, roughly 95% of all people with HIV/AIDS live in the developing world, where there is virtually no access to antiretroviral treatments. In the U.S., HAART contributed to a significant decline in the annual number of AIDS-related deaths between 1996 and 1998.

22. Is there a vaccine to prevent HIV infection?
Despite continued intensive research, experts believe it will be at least a decade before we have a safe, effective and affordable HIV vaccine. And even after a vaccine is developed, it will take many years before the millions of people at risk of HIV infection worldwide can be immunized. Until then, other HIV prevention methods, such as practicing safer sex and using sterile syringes, will remain essential.

23. Where can I get more information about HIV and AIDS?
There are many valuable sources of HIV/AIDS information, including the following:

• Community AIDS Service Penang (CASP)
46, Jalan Thomas, 11600 Penang, Malaysia
Tel. 604-6561554; 604-6560935 Fax: 604-6561017
Counseling & VCT: Monday – Friday, 9.00am – 6.00pm

• Malaysian AIDS Council Hotlines
Malaysian AIDS Council (03) 4045 1033
* Monday – Friday, 8:30AM – 5:30PM

• Other Information & Support Hotlines
PT Foundation (03) 4044 5455 or (03) 4044 5466
? Confidential information relating to HIV/AIDS and sexuality issues
? Monday – Friday, 7:30PM – 9:30PM
? Positive Living Line (for people for HIV): (03) 4044 9622

The Befrienders (03) 7956 8144
(03) 7956 8145 (Kuala Lumpur)
(05) 547 7933 / 547 7955 (Ipoh)
(04) 281 5161 / 281 1108 (Penang)
(06) 284 2500 (Malacca)

AIDS Action Research Group (04) 656 5984 (Penang)

Copyright (c) 2008 COMMUNITY AIDS SERVICE PENANG (CASP) All rights reserved