You can be a leader in your own world when you are well armed with facts about the virus and its ways of spreading. Knowledge, hopefully is the most effective tool that leads to prevention.

Yet another ‘World AIDS Day’ was marked at a juncture, the disease is slowly taking lives and spreading its deadly wings throughout the world.

This day which was one celebrated with much colour before, had passed as just another “Day’ with a few banners appearing around the cities of Sri Lanka.

According to health experts, Sri Lanka is facing two challenges in prevention of HIV and taking care of the HIV/AIDS patients. One is the number of HIV/AIDS patients in Sri Lanka is silently going up and the second is more and more women, who had ‘one faithful partner’ throughout their lives, are in danger.

Still the social stigma attached to the HIV virus has shut out victims from mainstream life in the society making them more isolated sadly leading to hatred. ‘Leadership” is the theme of the Day.

Therefore, we think that one of the most important things that we can do for you is to re-fresh your mind on HIV/ AIDS.

It will be a tool for you to avoid a disaster. If you have a better understanding of HIV, you are better equipped to ensure that people living with HIV are treated fairly and with dignity and respect, and play our part in preventing the spread of HIV. You can be a leader in your own world when you are well armed with facts about the virus and its ways of spreading. Knowledge, hopefully is the most effective tool that leads to prevention.

What is HIV?

HIV is a virus that attacks the body’s immune system-the body’s defence against diseases. Latest research suggests that between 70 and 90 per cent of people may experience symptoms of infection a few days after having been infected.

Three symptoms occurring together: fever, rash and a severe sore throat should always be considered a potential indicator of HIV infection. These symptoms usually disappear within two or three weeks.

Some people may not experience these early symptoms. In all cases, without effective treatment the immune system will become very weak and no longer be able to fight off illnesses.

Are HIV and AIDS the same

No. When someone is described as living with HIV, he or she has the HIV virus in their body.

A person is considered to have developed AIDS when the immune system is so weak it can no longer fight off a range of diseases with which it would normally cope with.

Is there a cure for HIV?

No, but treatment can keep the virus under control and the immune system healthy. People on HIV treatment can live a healthy, active life, although they may experience side effects from the treatment. If HIV is diagnosed late, treatment may be less effective in preventing AIDS.

What’s it like living with HIV?

If people with HIV are diagnosed early and respond to treatment they can be healthy, work and have relationships like anyone else and have a long life expectancy.

Coming to terms with an HIV diagnosis and getting used to treatment can be very difficult however, and people living with HIV will often need support from healthcare providers, friends and family, employers and support organisations. (Read following real story from a person who is living with HIV).

Why do people find it hard to tell others they’re HIV positive?

People living with HIV may find it hard to tell others about their condition as they worry that people will reject them, or they will experience prejudice from friends, family and colleagues. People living with HIV can also experience discrimination in their workplace, in healthcare settings (for example GPs and dentists), from members of their local community and through the media.

HIV prejudice is often the result of ignorance about how HIV is passed on and unfounded fear of becoming infected. Encouraging those around us to talk about HIV and find out the facts can help overcome this.

How is HIV passed on?

HIV can be passed on through infected blood, semen, vaginal fluids or breast milk. The most common ways HIV is passed on are:

- Sex without a condom with someone living with HIV - Sharing infected needles, syringes or other injecting drug equipment - From an HIV-positive mother (to her child) during pregnancy, childbirth or breastfeeding

Can you get HIV from kissing?

No. HIV cannot be passed on through:

- Kissing or touching - Spitting, coughing or sneezing - Toilet seats, swimming pools, or shared facilities or utensils *Can women living with HIV still have a baby?* Yes. HIV can be passed from mother to child, but there are steps that can be taken to reduce the possibility of the child contracting HIV to less than one per cent, including giving the mother and child antiretroviral HIV drugs, delivering the child by Caesarean and not breastfeeding the baby.

Could I get HIV?

If you are sexually active or share needles you could be at risk from getting HIV. Although anyone can become infected, some communities in the UK have higher rates of infection, such as gay and bisexual men and Black African men and women.

How can I protect myself from HIV?

Always use a condom when having vaginal or anal sex. You also may want to use a condom or dental dam during oral sex although the risk of transmission of HIV is much lower. Always use a condom that carries the European CE safety mark. You can get free condoms from a family planning or sexual health clinic.Never use syringes or any other injecting equipment used by another.

What do I do if I’ve put myself at risk?

If you think you have placed yourself at risk from infection by HIV you can ask for a free and confidential test at your local sexual health clinic.

If you are within 72 hours of an incident of possible exposure to HIV, ask for PEP (Post Exposure Prophylaxis) treatment from a sexual health clinic or at your nearest hospital accident and emergency department. PEP treatment can stop you becoming infected with the virus after you have been exposed to HIV.

The sooner treatment is begun the higher the probability the treatment will be effective.

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This is Leslie’s story which tells you how he feels different when he was helped by others to fight with the virus.

In the month of November in 1995, I was diagnosed with a bad patch of shingles around my head. I had suffered with shingles previously as a boy, but this had cleared up with antibiotics within a few days. This time I was still suffering way after the drugs had finished.

I went back to my GP for further tests, and was told that it appeared that my immune system had broken down and they would like to do an HIV test.

Rather shocked, I agreed, and was diagnosed positive the day before my birthday, which also happens to be World AIDS Day - 1st December.

I was told by my specialist at the hospital to try to avoid any stress, and was put on a high dosage of pills. My wife and family stood by me, together with close friends and extended family whom I told about it soon after finding out about my condition. However, the most unexpected and distressing problems were still to come. My GP, whom I had known personally and closely for twenty-six years, on finding out about my HIV diagnosis, sent me a letter telling me to find another local GP. My wife, three children and eighty-five year old mother were also asked to leave the practice in a similar way. My initial assumption was that the practice must be going private or my GP retiring. I made an appointment to see my GP and clarify the situation.

The events that followed made me sad to realise that when diagnosed with HIV you don’t just have to deal with the physical symptoms of the virus. I was waiting to see my doctor when the assistant doctor came out and said that he would see me instead. I agreed and asked him why, after twenty-six years, I had been cold shouldered by the G. P. He asked if I had been diagnosed HIV positive.

I confirmed that I had, as he well knew because he had my notes, and asked him what the problem was. He coolly told me that this was my doctor’s practice and he could choose who he had on his patient list, and he didn’t want somebody like me. My family had also been taken off the list in case I should accompany them into the doctor’s room. I was so shocked I returned to the waiting room and said I would wait as long as it took to see my doctor so he could explain this to me himself.

Ten minutes later two police officers entered the surgery and asked for me by name. I confirmed whom I was and was promptly asked to leave as I was told that I was no longer a patient at this surgery and was therefore trespassing. I tried to explain that I was waiting for an appointment to see the doctor, but was once again and more forcibly asked to leave. Not wanting to be arrested I obliged. An hour later I returned to seek the explanation from my GP that I felt I deserved and once more the police were called before I could speak to my doctor.

The fact is you can’t catch HIV by being in a waiting room with somebody that has it, and a doctor of all people should know that. What I needed from my GP was advice, support and medication and what I got was prejudicial and discriminatory attitudes from someone who should have been medically there to help me.

And as a doctor I believe he should have been setting an example to the rest of the community.

Six years later, having received the help I needed from more informed, AIDS educated people I am stronger and healthier than ever. I am lucky, as I have received great support from my family, friends and workmates, although I know of many people for whom the stigma of HIV and AIDS has resulted in them still being isolated, ostracised and sometimes even disowned. It is this kind of behaviour that makes people with HIV too afraid to even seek treatment, and those at risk too afraid to go for testing.

Yet today, thanks to new treatments, it is possible for most people with HIV to lead full and active lives without putting anyone else at risk. If only people will let us.

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You and your baby

Twin pregnancy and management

by Dr. Vijith VIDYAVIBUSHANA,

Consultant Gynaecologist, Castle Street Hospital for Women

Following fertilization of the egg by the sperm, the resultant cell ( new life) starts to divide subsequently. This dividing cell mass travels through the fallopian tube towards the lining of the womb. The movement of fine hair-like structures in the lining of the fallopian tube, together with the effect of hormones help this cell mass to go in to the right direction. About four days after fertilization it divides into sixteen cell stage (this stage is called Morula) and then it burrows in to the lining of the womb when it reaches the womb. This process is called ‘implantation’. Some women can have little amount of bleeding through vagina when the pregnancy burrows into the lining of the womb between four to ten seven days after fertilization (about three weeks from the last menstrual period). This can lead to confusion when calculating the expected date of delivery using last menstrual period (LMP) if this implantation bleed is considered as the first day of menstruation.

What is an ectopic pregnancy?

If the lining of the tube has been damaged by infections or inflammation, this process of travelling of the morula will be interfered with, and the pregnancy burrows into the lining of the fallopian tube giving rise to an Ectopic Pregnancy. One out of 100 women can have a pregnancy outside the womb (Ectopic pregnancy) which can be life-threatening.

How do women get twins?

Twinning can occur due to several reasons. If one releases more than one egg (two) in the same menstrual cycle, two sperms will fertilize these eggs giving rise to two pregnancies (twins). This kind of twins are called non-identical twins. They live in two separate water bags and they get their nutrition through two separate placentae inside the womb. Eighty out of hundred twins belong to this type.

Twenty percent of twins are called identical twins. These twins originate from the same egg and sperm. Once fertilization occurs the egg and sperm will form a ‘new cell’ or ‘new life’ and this cell can divide in to two complete cell masses (embryos) and behave as if they arose from two eggs. These twins although identical burrow in to the lining of the womb separately and therefore will have two separate water bags and two separate placentae.

This division in to two separate embryos can happen even after the pregnancy burrows in to the lining of the womb.

This kind of twins are identical but they share the same placenta. Sharing the same placenta can give rise to problems during the pregnancy and therefore they have to be looked after very carefully during pregnancy. If this division occurs four to seven days after fertilization these babies will have the same placenta but live in two separate water bags (called Monochorionic diamniotic). If this division occurs between seven to thirteen days after fertilization these twins share the same placenta and live in the same water bag (called Monochorionic Monoamniotic).

These kind of twins can have complications during the pregnancy and delivery and fortunately it is not a common variety.

Conjoint twins occur when this division occurs after 13 days of fertilization. These twins are attached to each other from head, chest, tummy or bottom and sometimes share the same organs.

These kind of twins too are very rare.

We can diagnose all types of above twins very accurately by performing an Ultra Sound Scan before twelve weeks following last menstrual period. This scan is the most important one for a twin pregnancy as the management of the pregnancy depends on the type of the twins.