HIV control system sitting on laurels?

by Shanika Sriyananda

A quarter century has passed. Despite its deadliness, the No. 1 killer disease still exists in the same deadly form amidst 'global' attempts to find a miracle drug to cure Human Immuno Virus (HIV) which causes Acquired Immuno Deficiency Syndrome (AIDS).

Due to ignorance, poverty and changing behavioural patterns the number of HIV/AIDS victims keeps on increasing by not twofolds but by 'manyfold'.

The first Sri Lankan with HIV/AIDS was discovered in 1987 and 815 HIV cases have been reported upto now according to the HIV/AIDS Surveillance data. However, the country can still 'boast' of a low prevalence rate (0.05 per cent). But the number of new positive cases reported each quarter would indicate the gravity of the problem. In each quarter from the third quarter of 2004, nearly 30 new HIV cases have been reported in Sri Lanka.

Over 82 per cent of the HIV infected are in the 15 to 49 age group.

Though this increase in detection could be due to better facilities or due to better monitoring, there is still a great need of making people aware of the dangers.

In an interview with the 'body & soul' Dr. Shantha Hettiarachchi, Co-ordinator of the Information Education and Communication of the National HIV/AIDS Prevention Project said that despite the very low prevalence rate compared to other countries, the estimated number of nearly 5,000 adults and 100 children infected with HIV/AIDS were living in Sri Lanka.

"Several awareness programs at village levels to educate the rural youth were launched. What we observe is, despite these awareness programms still there is room for such programms. Especially, the rural youth have a keen interest in gaining knowledge about the diseases and it is a good sign", he added.

He said that though the highest number reported was from the Western Province, the disease was seen emerging from other provinces as well.

The mode of Transmission of HIV

Sexual: 96%

Heterosexual - 85%

Homosexual - 11%

Perinatal transmission 3%

Transmission through blood 1%

* Blood:

Transfusion of infected blood/blood products, injecting drugs

* Mothers to Child, In Utero, At delivery, Breast feeding.

HIV - Does not Spread by touching, kissing, insects, using common items - toilets, eating utensils, swimming pool, river. When HIV enters the body some symptoms - headache, fever, rash, enlargement of lymph nodes, nausea, vomiting, diarrhoea, may appear within a few weeks. But these symptoms will disappear in a few weeks. Symptoms free interval for several years while viral replication continues.

Patients cannot be identified during this period. Viral Replication are influence on white blood cells (immune cells), impaired immunity, bacterial, viral, fungal infections.

The stages of HIV infection are:

a) Primary HIV infection.

Usually starts two to four weeks after infection.

The patient may develop fever, lymphadenopathy, loss of appetite, lethargy, body aches and pains, skin rash, headache, peripheral neuropathy, cough, vomiting and diarrhoea. These clinical features will disappear gradually.

b) Early immune depletion.

This is characterized by long period of good health with periodic episode of ill health, The generalized lymphadenopathy may be noted in this stage. Some neurological symptoms may also be developed.

c) Intermediate immune depletion.

The patient gets various infections in this stage as the immunity is impaired. Most common manifestations are, unexplained weight loss, fever, skin infections, infections in the mouth, lymphadenopathy, and infections in the genital region.

d) Advanced immune depletion.

This is the stage of AIDS. Clinical manifestations are, more than 10% of weight loss, persistent fever or diarrhoea (more than one month), extrapulmonary tuberculosis or disseminated tuberculosis, candidiasis of the oesophagus, multidermatomal or recurrent herpes zoster etc.

Mother to child transmission.

An infected mother can transmit the infection during pregnancy, delivery or through breast feeding. The risk of transmission from an infected mother to child is 20 to 45 per cent.

This risk can be minimised up to 8 per cent if the mother was tested for the HIV and diagnosed in her pregnancy.

If the mother was diagnosed as having infected with HIV, she will be given antiretroviral drugs from the 28th week of pregnancy. The baby will be delivered through caesarian section. This blood test (HIV antibody test) can get done from the same blood sample which is taken for other screening test in the antenatal clinic if the consent was given.

Management of HIV infected person.

* Counselling - on maintenance of health, nutrition, stress reduction, prevention of transmission.

* Medical follow up - with regular serological testing.

* Early detection of opportunistic infection and treatment.

* Anteretroviral therapy when indicated. (If the CD 4 Cell Count is bellow 200 per Microleter in blood or the patient is having AIDS defined illness).

According to Dr. Hettiarachchi, 85 HIV infected patients are now given antirretroviral drugs free of charge.

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 Exercise during pregnancy

Maintaining a regular exercise routine throughout your pregnancy can help you stay healthy and feel your best. Regular exercise during pregnancy can improve your posture and decrease some common discomfort such as backaches and fatigue. There is evidence that it may prevent gestational diabetes (diabetes that develops during pregnancy), relieve stress and build more stamina needed for labour and delivery.

If you were physically active before your pregnancy, you should be able to continue your activity in moderation. Don't try to exercise at your former level; instead, do what's most comfortable for you now.

Low impact aerobics are encouraged versus high impact. Do not let your heart rate exceed 140 beats per minute.

If you have never exercised regularly before, you can safely begin an exercise program during pregnancy after consulting with your healthcare provider, but do not try a new, strenuous activity. Walking is considered safe to initiate when pregnant.

The American College of Obstetrics and Gynaecology recommends 30 minutes or more of moderate exercise per day on most if not all days of the week, unless you have a medical or obstetric complication.

Who should not exercise?

If you have a medical problem, such as asthma, heart disease or diabetes, exercise may not be advisable. Exercise may also be harmful if you have an obstetric condition such as:

Bleeding or spotting, Low placenta, Threatened or recurrent miscarriage, Previous premature births or history of early labour, Weak cervix, Talk with your health care provider before beginning an exercise program. Your health care provider can give you personal exercise guidelines, based on your medical history.

What exercises are safe during pregnancy?

Most exercises are safe to perform during pregnancy, as long as you exercise with caution and do not overdo it.

The safest and most productive activities are swimming, brisk walking, indoor stationary cycling and low-impact aerobics (taught by a certified aerobics instructor). These activities carry little risk of injury, benefit your entire body, and can be continued until birth.

Tennis and racquetball are generally safe activities, but your change in balance during pregnancy may affect rapid movements. Other activities such as jogging can be done in moderation.

You may want to choose exercises or activities that do not require great balance or coordination, especially later in pregnancy.

To learn strength and toning exercises that are safe to do during pregnancy, see Sample Exercises. What exercises should be avoided during pregnancy?

There are certain exercises and activities that can be harmful if performed during pregnancy. Avoid: Holding your breath during any activity. Activities where falling is likely (such as skiing and horseback riding).

Any exercise that may cause even mild abdominal trauma such as activities that include jarring motions or rapid changes in direction. Activities that require extensive jumping, hopping, skipping, bouncing or running.

Deep knee bends, full sit-ups, double leg raises and straight-leg toe touches.

Bouncing while stretching.

Exercises that require lying on your back or right side for more than three minutes. (especially after your third month of pregnancy). Waist twisting movements while standing.

Heavy exercise spurts followed by long periods of no activity. Exercise in hot, humid weather.

WebMD Medical News

How parents can deal with... A lazy child

A lazy child will usually dawdle, procrastinate and use time poorly. More specifically, lazy means inactive, not energetic, sluggish and disinclined to actions. Children under 8 years of age are usually not able to use time wisely and be punctual on their own.

As such it is typical for children of this age to require guidance and aid in planning, in order to have assignments in on time or do chores within a specific time period.

Reasons why

1. Child is exerting his independence and power especially when parents are too controlling.

2. Child is expressing anger passively or seeking revenge because of frequent punishment and nagging.

3. Child is avoiding any type of situation that is unpleasant to him.

4. Child is completely discouraged and feels that it is useless to try. There is a fear of failure.

5. Child is not recognised or praised for task completion. There is no positive feedback or supervision.

6. Parents have not developed a routine in getting child to complete tasks within a time limit.

7. Parents have unrealistic expectations. Task is beyond child's mental or physical capabilities.

How to prevent

1. Build a close and loving relationship with your child by spending sufficient quality time alone with him.

2. Set realistic standards that is within your child's capability,

3. In your discipline method, use more encouragement and rewards than punishment.

4. Accept and recognise child's feelings of anger or frustration on having to perform a task that he dislikes.

5. Try to make completion as fun and interesting as possible.

What to do

1. Have a very clear routine for your child. Plan with your child a timetable for play, rest, study and chores.

2. Praise or reward your child for any efforts at task completion.

3. Use a chart to record how often he does a task like doing his homework and challenge him to do it more often. A point system can be used where your child secures points for accomplishing allocated tasks. These points can earn him rewards and privileges.

4. Establish a contact with your child. Grant him some privileges or rewards for completion of specific tasks.

5. Offer your child something pleasurable like watching TV or going down to the playground after he completes a task that he dislikes.

6. Be consistent in rules and discipline.

7. Teach your child how to perform task by breaking task down into learnable parts; for example, in wiping a spill, he can first take a piece of cloth, wet it and clean spill. He can then wash cloth and hang it to dry. Show and help child before getting him to practise.

8. Supervise your child and give him positive feedback in order to direct, help, encourage and motivate him to establish firm habits.

9. Be willing to negotiate and work out solutions for disagreement or conflict.

What not to do

1. Punish, criticise, threaten, nag, shout or confront child.

2. Demand obedience.

3. Expect perfection.

4. Redo tasks performed by child or complete tasks for child like cleaning his room.

Source: Handling Common Problems of Children.