AIDS (Acquired Immuno-Deficiency Syndrome) has emerged as a new and serious health emergency in Manipur. The first HIV positive case in Manipur was officially reported in February 1990 from the blood samples of October, 1989 among a cluster of Injecting Drug Users (IDUs) tested in the Surveillance Centre of AIDS at the Department of Microbiology, RIMS by Elisa test (confirmed by Western Blot at NICED, Kolkata).

Situation of HIV & AIDS in Manipur:

Period : September 1986 to August 2005 :

Sentinel Surveillance Report:

Changing HIV/AIDS Scenario in Manipur:

•  The infection has spread from the high risk group (IDUs) to the general population.

•  The infection has spreads to the sexual partners of the IDUs & their children.

•  Weaves of HIV epidemic is occurring among women (feminism) & children.

•  Infection is spreading from urban to the rural population.

•  Increased infection among young people.

•  Manipur is one of the six high prevalent states in India.

HIV / AID situation in India:

UNAIDS had estimated that there are already 4.58 million people living with HIV/AFDS by the end of December, 2002. By the end of November, 2003 NACO has reported 57,781 AIDS cases in India.

HIV /AIDS Global Scenario:

UNAIDS estimates that there are 42 million people living with HIV/AIDS by the end of 2002. Out of the 42 million, 19.2 million are women, 19.6 are men and 3.2 million are children. Altogether, 14,000 new HIV infections are occurring everyday, of which 49.6% are women. 5 million people are acquiring HIV infection every year, of which 800,000 are children.

Transmission of HIV infection:

1. Unprotected sexual intercourse with an infected person.
2. Transfusion of infected (unscreened) blood or injection of infected blood products.
3. Sharing of contaminated syringes, needles or injecting equipments.
4. Through use of infected donated organ transplant and semen (artificial insemination).
5. From infected mother to child.
6. Accidental inoculation of infected needles & sharps (occupational).

HIV is not transmitted by:

•  Close contact, interpersonal contact of a non-sexual nature with an infected person such as shaking hands, touching, hugging, kissing.

•  Sharing of food, utensils, crockery, cutlery, sharing of washing and toilet facilities, bathrooms, swimming pools, telephones etc.

•  Living together in the same house or being part of the family.

•  Donated blood (screened).

•  From sneezing or coughing or breathing of the infected person.

•  Through water, air, insect bites.

•  Saliva, tears, sweat.

Prevention from HIV infection:

•  Delay sex till marriage.

•  To marry HIV free spouse.

•  After marriage, practice monogamy.

•  To use a condom whenever you have sex with unknown sexual partners.

•  To avoid sharing of infected syringes & needles.

•  To avoid transfusion of unscreened blood.

•  To avoid taking injection with unsterile injecting equipments.

•  To avoid occupational exposure e.g. needle prick injury, splashes to the membranes etc.

Voluntary Confidential Counselling & Testing Centre (VCCTC):

It is the entry point for the general population to access prevention, Care and support services. The services provided are "client centred" and the client is empowered to make informed decisions on the basis of test results. Pre test, HIV test and post test services are provided along with referral, services to ART Centre, PPTCT and various NGOs working with the care of people living with HIV/AIDS (PLWH/A).

VCCTC at the Department of Microbiology, RIMS, Imphal is one of the three model VCCTCs in India . In Manipur every district is having one VCCTC.

Antiretroviral Therapy:

Therapy is given for patients whose CD4 count falls below 200 cells/mm3. The optional time to start ART for asymptomatic patients with CD4 + T cell counts > 200 cells/mm3 is not known. Recommendation for therapy in this group should be based on patients' wishes for therapy, the CD4 count and rate of decline of CD4 count. Initial regimen of 2 Ncleoside Reverse Transcriptase Inhibitors with one Non Nucleoside Reverse Transcriptase Inhibitors is effective and recommended, spares Protease Inhibitors and with low pill burden, is often preferred over other regimens. A combination of d4T (stavudine)/3TC (Lamivudine) and NVP is available in a single pill in some countries: it is relatively expensive and may be given twice daily. The combination of Zidovudine (ZDU/Lamivudine (3TC) and NVP (Nevirapine) is also available.

A regimen containing 3 NsRTIs (Abacavir, zidovudine, lamivudine) has twice daily convenient dosing with fewer drug interactions but may be less effective in patients with high viral load. There is concern about Protease Inhibitors related toxicities & drug interaction. Monitoring of therapy is essential.

There are ART Centres providing free ART at RIMS Hospital and J.N. Hospital, Porompat. Facilities of FACS Count machine (CD4 estimation) is available at RIMS Hospital and J.N. Hospital . More facilities for CD4 testing and ART will be available in the state.

Issues of HIV/AIDS and Surgeons:

•  Mandatory HIV testing before operation should not be practised as it is unethical and against the state AIDS policy.

•  Universal precaution and all bio-safety measures should adopted by the surgeons in the hospital during patient care (including operation).

•  Post Exposure Prophylaxis facilities are available at RIMS Hospital and drugs should be taken if recommended within 2 to 6 hours in case of occupational exposure (guidelines to be followed). PEP facilities are available at RIMS hospital, J.N. Hospital and some other health centers.

•  Hospital Infection Control Committee of the Health set up should be strengthened.

•  Surgeons should discharge duties to the PLWH/A (people living with HIV and AIDS) with love & sympathy.

•  Surgical skill should be developed to avoid accidental needle pricks injury.