LOOMING CLOUDS The threat of AIDS Dr Sanjay De Bakshi MS(Cal.); FRCS(Eng.);FRCS(Edin). An estimated 2 to 5 million Indians affected (1997 NACO study)

“Addressing some myths” Which group has the highest incidence of HIV in India? 1.Unmarried women? 2.Divorced and separated women? 3.Married women?

Which profession is most affected? Skilled labour? Service? Professional? Labourer? Housewife/Unemployed? CSW? Business? Vendor? Clerk?

Spread of AIDS the “Ripple effect” CORE GROUP BRIDGING GROUP GENERAL POPULATION

Prevalence of AIDS in India The problem of India is that of a large body of unsuspecting, uneducated general public. The problem of medical personnel and surgeons in particular, is that of treating patients many of whom will have the disease without realising it.

Status and Stats for India Cases of HIV in India Could Surpass South Africa By Brian CarnellBrian Carnell Wednesday, May 8, 2002

TELEGRAPH 22nd January 2001 “AIDS cloud on housewives” “NACO” PER- CENT

Stats for India ; Southern & Central Population Screened

Stats for India; Southern & Central Number Tested Positive

Stats for India; Southern & Central Seropositivity Rate{per Thousand}

The Statesman on 26 th Aug carried the story of 4 young doctors, 2 from King George Medical College, Lucknow and 2 from Kanpur Medical College who tested positive for HIV. Dr Bachittar Singh; Project Director of Uttar Pradesh AIDS Control Society confirmed officially that they had acquired the infection while treating patients with HIV.

PROBLEM OF AIDS for the Health Care Provider

FACTS The HIV Virus has been isolated in the following:- SECRETIONS EXCRETIONS SALIVA CSF TEARS BLOOD VAGINAL SECRETIONS MILK SEMEN AMNIOTIC FLUID URINE

FACTS Some trials

FACTS Some other trials

FACTS A trial involving 1231 dentists:- Only one was found to be sero-positive; he NEVER WORE GLOVES- “They are only for sissies”- he is reported to have said.

First -there is an error rate(both +ve and -ve) for both the ELISA and the Western Blot tests. Second -Infected patients may be in the “window period” between exposure and sero-conversion. Third - testing requires the patient to consent. What happens if the patient refuses? Fourth -though some doctors feel that they will be able to take additional security measures for the HIV patient, ALL studies show no statistical difference between needle-prick and other exposures. Transmission is therefore a fact, should we be testing ALL patients?

Continued- Fifth- Results of the tests may not be available before surgery particularly in the emergency setting. Sixth- Testing solely for HIV will not identify those patients who pose other hazards to health care workers. ( In one study, testing solely for HIV alone would have failed to identify HBV in 87% and HCV in 80%).

Committee for Disease Control {CDC-Atlanta}

Suggested precautions (CDC) Routine use of gloves-  Surgery  Examination of open wounds and body fluids  Venesection or other vascular access  Handling soiled material Non-permeable gowns and face masks with visors should be used when procedures likely to generate splashes of blood or other body fluid.

Results of a questionnaire from two private hospitals in Kolkata Do you wear gloves when you start an intravenous infusion?

Precautions (contd.)- Hands and other skin surfaces should be washed thoroughly if contaminated. PREVENT “SHARPS” INJURY-  Needles should never be recapped or broken by hand.  Care should be taken when working in closed spaces.  “Sharps” should be placed in a puncture-proof container.  Containers should be placed as close as possible to the work area.

''The public attention and awareness of this problem has lagged behind the scope of it,'' said Dr. Linda Rosenstock of the Centers for Disease Control and Prevention.(November 1999.) ''For every 100 beds a hospital has, on average it has 30 needle stick injuries per year.''

Results of a questionnaire from two private hospitals in Kolkata Do you use your hand to recap needles?

Results of a questionnaire from two private hospitals in Kolkata Do you discard used needles and syringes in the usual waste paper basket?

Precautions (contd.) Although not implicated yet, providing for ventilation devices will cut down on the need for mouth-to-mouth resuscitation. All Health Care Workers with open wounds or exudative lesions should avoid risk. Food, drinks,re-applying cosmetics and putting on contact lenses should be avoided in the working area.

Results of a questionnaire from two private hospitals in Kolkata Have you worked in the last 3 years with a cut on your hand?

Transmission of the HIV Virus to the patient

Transmission from an HIV positive doctor The incidence of infection to a single patient from an HIV positive doctor ranges from %(1 in 42000) to %(1 in ). However, the CUMULATIVE risk of transmission of infection from an HIV positive surgeon to a patient, considering his entire surgical lifetime, is 8.0% to 8.1%. THESE STATISTICS -RESPONSIBLE FOR LEGALLY DENYING AFFLICTED DOCTORS, FROM CONTINUING TO PRACTICE IN HIGH RISK JOBS IN THE U.S.A.

Transmission from Inadequately sterilised equipments and improperly tested blood. Blood and needles. Endoscopy units. Dialysis departments. Surgical instruments.

Transmission by ignorance!!! “DEADLY SYRINGES REUSED IN THE U.S.A.” Syringe manufacturers say it doesn't happen. Doctors claim they wouldn’t dream of doing it, and most patients have never even heard of it. But the medical reuse of unsterile syringes in the United States is a problem. Last year a medical doctor, in Monroe, Conn., reportedly gave free flu shots to almost 500 people with syringes reused up to 10 times each. Even after a nurse told town authorities what had happened, the doctor refused to admit that he had done anything wrong. “For years this has been a perfectly acceptable procedure,” he told one Connecticut television station. “I didn't know the procedure had changed.”

Contd.:- In 1995, a study published in the American Journal of Anesthesiology found that 39 percent of anesthesiologists reported using the same syringe on different patients.

PRINCIPLES OF ANTI-SEPSIS Laid down ages ago. It will indeed be a pity and a travesty of justice, if in the year 2002, we choose to ignore their teachings!!!!!

CDC GUIDELINES FOR TREATMENT OF EXPOSURES

PEP REGIMENS SUGGESTED

THE ACTUAL STATISTICS TODAY!

For him, there is no tomorrow, his name is-