Disease Diabetes Mellitus (DM)

Disease Diabetes Mellitus (DM), also known as diabetes or blood sugar disease is a chronic disease group characterized by an increase in blood sugar levels as a result of disturbances in the body's metabolic system, where the organ pancreas unable to produce insulin the body needs.

Insulin is one of the hormones produced by the pancreas which is responsible for controlling the number/blood sugar and insulin is needed to change (process) of carbohydrates, fats, and proteins into energy needed human body. Lower insulin function in blood sugar levels.

1. Signs and Symptoms of Diabetes Mellitus

Early signs that it is known that a person suffering from DM or diabetes that can be seen directly from the effect of increasing blood sugar levels, which increase blood sugar reaches 160 to 180 mg/dL and urine (urine) diabetic containing sugar (glucose ), so the urine is often surrounded by ants.

People with diabetes generally show signs and symptoms below, although not all patients experience:

1. Number of urine issued more (Polyuria)
2. Often or quickly feel thirsty / thirst (Polydipsia)
3. Excessive hunger or eat a lot (Polyphagia)
4. Increased urine frequency / urine kept (glycosuria)
5. Losing weight is not clear why
6. Tingling / numbness nerve endings in the hands & feet ditelapak
7. Quick tired and weak all the time
8. Myopic vision experience sudden
9. If the wound / etched (korengan) slow healing
Especially 10.Mudah infection of the skin.

Condition drastic sugar levels rapidly decrease will cause a person to become unconscious and even entered the stage of coma. Symptoms of diabetes can develop quickly over time in a matter of weeks or months, especially in a child who suffered from diabetes mellitus type 1.

Another case in people with type 2 diabetes mellitus, they generally do not experience the symptoms above. Even they may not know has suffered from diabetes.

2. Disease Type Diabetes Mellitus

1. Diabetes mellitus type 1
Diabetes type 1 diabetes who are dependent on insulin deficiency where the body of the hormone insulin, known as Insulin Dependent Diabetes Mellitus (IDDM). This is due to the loss of insulin-producing beta cells in the islands of Langerhans of the pancreas. Type 1 diabetes is usually found in infants, children and adolescents.

Until recently, type 1 Diabetes Mellitus can only treat with the provision of insulin therapy continuously conducted continuously. Family history, diet and environmental factors influenced the treatment of type 1 diabetes. In type 1 diabetes should be considered controlling and monitoring blood sugar levels, you should use a blood sugar test. Especially in children and toddlers which they very easily become dehydrated, vomiting and often prone to various diseases.

2. Diabetes mellitus type 2
Diabetes type 2 is where the hormone insulin in the body can not function properly, known as Non-Insulin Dependent Diabetes Mellitus (NIDDM). This is because the various possibilities such as defects in insulin production, insulin resistance or reduced sensitivity (response) and sell the body tissue to insulin is indicated by rising levels of insulin in the blood.

There are several theories that articulate the cause of insulin resistance, including obesity factors (obesity). In type 2 diabetes, controlling blood sugar levels can be done with some measures such as diet, weight loss, and the provision of diabetic tablets. If the provision is not maximized tablet treatment response in blood sugar levels, then injecting the drug began to be considered.

3. Blood sugar

Normal blood sugar levels ranging from 70 to 150 mg/dL (millimoles/liter (United Kingdom unit)) or 4 to 8 mmol/l (milligrams/deciliter (United State unit)), Where 1 mmol/l = 18 mg/dl.

However, of course sugar levels increase after eating and decreased at a time when early morning waking. Someone said to have hyperglycemia when the blood sugar levels well above normal values, while hypoglycemia is a condition where a person experienced a decrease in blood sugar values below normal.

Diabetes Diagnosis can be established if the results of the fasting blood sugar level reaches 126 mg/dL or even more, and checking blood sugar after 2 hours of fasting (minimum 8 hours) to reach the level of 180 mg/dl. Meanwhile, blood sugar tests are done at random (as) can help diagnose diabetes when blood sugar values reached levels between 140 mg/dL and 200 mg/dL, even more so when he over 200 mg/dl.

Many blood sugar testing devices that are traded today and can be purchased in many places selling medical devices or pharmacy as the Accu-Chek, BCJ Group, Accurate, OneTouch UltraEasy machine. For patients diagnosed with Diabetes Mellitus, it's good for them to be able to buy it.

4. Disease Treatment and Management of Diabetes

Type 1 diabetes generally undergo treatment insulin therapy (Lantus/Levemir, Humalog, Novolog or Apidra) is continuous, but it is by exercising sufficiently and controlling your diet (diet).

In people with type 2 diabetes mellitus, management of medication and treatment focuses on lifestyle and physical activity. Control values in blood sugar levels is the key to treatment programs, namely by reducing the weight, diet, and exercise. If this does not achieve the expected results, the tablet drug delivery would be required. Even giving insulin injections is required when a tablet'm not cope with controlling blood sugar levels.


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Strained Brain Not Enough with Games

Quality of life can not be obtained in a way that instant. No exception as we aspire to have a brain that stay sharp until the old. When we heard that games like Sudoku or crossword puzzles can help to improve the sharpness of the brain, we were excited to play it straight. But after a month, those efforts began to fade, and eventually disappeared.

Things like this may be different, if we do so with full awareness. Moreover, factors that can help sharpen the brain was not only to his game. If there were a few things you can do, surely you will be more relaxed with it. Ready to put this activity into daily routines?

Playing Scrabble hobby. Games such as scrabble, sudoku, and crossword puzzles, intended to sharpen intelligence. We are so stimulated to remember many words in a relatively short time. Another benefit of this brain teaser, according to Cynthia Green, PhD, director of the Memory Enhancement Program at Mount Sinai School of Medicine, is a stress reliever. Author of Game Plan brainpower this encourages us to make the event a relaxation after work.

Meanwhile, according to Dr. Richard Restak, a clinical professor of neurology at George Washington's Medical Center, video games can also improve the sensor sensitivity and fast response if done wisely. The result, you are able to respond more quickly and more accurately the events that happen simultaneously.

Expand Omega-3 acids. We can enhance the brain by consuming omega-3. Well, we can protected from dementia. Omega-3 can be obtained by diligent eating tuna fish. Tuna fish is also rich in vitamin B12, to reduce the risk of Alzheimer's. Add one or two servings of food into the menu every week. The result, the risk of dementia can be reduced by 30 percent.

Omega-3 also can be obtained from walnuts. Nuts are also enriched with other ingredients that act as antioxidants to block free radicals cause damage to brain cells. In the meantime, blueberries contain antioxidants but also improve brain circuits.

Come to yoga class. This exercise is recommended by many experts. In addition to relaxing, yoga also increases the sharpness of mind and improve brain function thanks to the breathing exercises. Breathing exercises makes our lungs breathe more maximal oxygen useful for maintaining the health of brain cells.

Turn on the left hand. So far, we almost always use right hand to do many things. Occasionally, active with his left hand. For example, for eating, brushing teeth or combing hair. This could train the balance between left and right brain. Therefore, the left hand is controlled by the right brain, while the right hand, left-brain controlled. For a lefty, let's also occasionally switch the right hand.

Learn one word each day. Make this a new habit. When you do this, it means in a year you learn 350 new words or 3,000 words of a decade. Fair is not, because the functional vocabulary of the average adult is only about 10,000 words. According to scientists, learn new words involving language centers in the brain, the frontal lobe, and memory circuits.

Enjoy the art. Music will enhance the language and verbal skills, while the instrumental music will enhance the ability of the brain. Playing the instrument is also improving the agility of the fingers, that would increase longevity.

Keep a healthy weight. It is important to keep your body stay fit, because it has found that obesity is the biggest cause of dementia diseases in the elderly. Most important, obesity causes a decrease in functional ability in humans, such as intelligence, mental acuity, cognitive flexibility, and concentration.

Walk. Walk along the 1.6 km per day will reduce the tendency of developing dementia by 50 percent. If you do not have enough time, brisk walking for 45 minutes three times a week will also prevent the brain changes associated with age.

Sleeping during the day. Short nap for 20 minutes was enough to improve the memory, like when we sleep at night. Lie also improve your mood, restore concentration, and enhance creativity.

Master the new skills. Find something that interests you, and learn new things until they reach an expert level. For example, learning a foreign language, playing music, sports games, and so forth. This activity will enhance the long-term memory and cognitive reserve.

In a smaller scale, you can also challenge yourself to solve the puzzle, or memorizing a shopping list. A better memory will also enhance the imagination and creativity.**dunia90.blogspot.com**

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Pregnant but HIV positive

 The other day I received a call from a Gynaecologist of a nearby Hospital.


'I have an ante-natal [pregnancy] patient who is HIV positive. Should I send her to you now or after delivery?'

The doctor was asking me.

I was happy that she called to inform me, but was disappointed with her question. I had spend some effort as an HIV/AIDS trainer to make doctors aware that pregnant women need anti-HIV treatment to prevent the birth of a 'positive' child. I am not sure whether the above-mentioned doctor attended the training, but I expected her to know the importance of ART [anti HIV treatment] in pregnancy.

'You should send her to me immediately. She needs treatment to prevent the birth of a 'positive' child.' I replied.

The next day the patient came with her husband. I explained the situation to them in detail and asked them to attend the Govt ART center as early as possible. I telephoned the ART Medical Officer about this patient and fixed a suitable time for the patient to reach the center.

That lady will get the treatment, which will greatly reduce the chance of the birth of a 'positive' child from about 40% to less than 5%.

All pregnant females should be tested for HIV and if found positive should immediately receive treatment so that we can eliminate the chance of birth an HIV positive child

Should I give the cervical cancer vaccine to my daughter?

A mother of a 12-year-old girl was asking me this question the other day.


"Should I give my daughter cervical cancer vaccine?"

I was not prepared for the question. Though I know such a vaccine is available I have not studied it in detail. So my answer was little bit evasive.

' It is a new vaccine. Needs to be studied more .........."

I was curious why she asked the question.

"My sister who lives in USA gave her daughter the vaccine. I was wondering whether I should give it to my daughter too."



I realized that I would be asked similar questions again and again as the vaccine has been launched in India. More over I may have to take a decision about it personally since I have a daughter of about same age.

This post is an attempt by me to answer the question raised by that mother after considering all the facts available at present.



What is cervical cancer?

The cervix is another name for the neck of the womb. It is the opening to the womb from the vagina. It is really a strong muscle. Normally it is quite tightly shut, but during labour it opens up to let the baby out.



The cervix has a layer of skin-like cells on its outer surface. When these cells become cancerous it is called squamous cell cervical cancer.

There are glandular cells lining the inside of the cervix. The glandular cells produce mucus. Cancer of these cells is called adenocarcinoma of the cervix.



The area where cervical cells are most likely to become cancerous is called the transformation zone. It is the area around the opening of the cervix that leads on to the narrow passageway running up into the womb.



What causes cervical cancer?



HPV infection



Human papilloma virus or HPV is the major cause of cervical cancer. There are many different types of HPV. It is sometimes called the genital wart virus as some types of HPV cause genital warts. In fact, the types that cause warts are not the types that cause cervical cancer. But there are other types of HPV that are considered 'high risk' for cancer of the cervix. HPV is passed on from person to another through sexual contact.



Women who get cervical cancer have had past infections with HPV. High risk types of HPV can cause changes in the cells covering the cervix that make them more likely to become cancerous in time. It is said that around 50 to 80 % of women get infected with HPV some time in their lifetime.

Most people with HPV do not develop symptoms or health problems from it. In 90% of cases, the body’s immune system clears HPV naturally within two years.



But most women infected with these viruses do NOT develop cervical cancer. So other factors must also be needed for someone with HPV infection to develop cervical cancer.

HPV is passed on through genital contact, most often during vaginal and anal sex. HPV may also be passed on during oral sex and genital-to-genital contact. HPV can be passed on between straight and same-sex partners—even when the infected partner has no signs or symptoms.



A person can have HPV even if years have passed since he or she had sexual contact with an infected person. Most infected persons do not realize they are infected or that they are passing the virus on to a sex partner. It is also possible to get more than one type of HPV.



HPV can cause normal cells on infected skin to turn abnormal. Most of the time, you cannot see or feel these cell changes. In most cases, the body fights off HPV naturally and the infected cells then go back to normal. But in cases when the body does not fight off HPV, HPV can cause visible changes in the form of genital warts or cancer. Warts can appear within weeks or months after getting HPV. Cancer often takes years to develop after getting HPV.


Other risk factors for Cervical Cancer

Women who smoke are more likely to get cervical cancer than those who do not. Taking the birth control pill could increase a woman’s risk of cervical cancer. It is not clear why this is. Women with a weakened immune system are also more likely to get cervical cancer, as are those who have had a large number of children.

Preventive measures against HPV infection

For those who choose to be sexually active, condoms may lower the risk of HPV. To be most effective, they should be used with every sex act, from start to finish. Condoms may also lower the risk of developing HPV-related diseases, such as genital warts and cervical cancer. But HPV can infect areas that are not covered by a condom - so condoms may not fully protect against HPV.



People can also lower their chances of getting HPV by starting sexual activity at a later age, being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. And it may not be possible to determine if a partner who has been sexually active in the past is currently infected. That's why the only sure way to prevent HPV is to avoid all sexual activity.



Preventive measures against Cervical Cancer

Screening/PAP smear

Cervical screening is very important because we can stop cervical cancer from developing in the first place. This is one of the few cancers that are preventable because pre-cancerous cell changes can be picked up before they have a chance to develop into a full-blown cancer.

The screening test is often called a cervical smear. A nurse or doctor takes a small sample of cells from the surface of your cervix and spread straight onto a glass slide or put into a liquid. When it reaches the lab, your sample is put under a microscope. The cells are examined and any abnormal ones reported.

The smear test picks up pre-cancerous changes. If you have an abnormal result, it does NOT mean you have cervical cancer. But you may need further tests or treatment for an abnormal smear.

You have to be screened like this every 3 to 5 years from 25 years of age.



Vaccine against HPV

Now I come to the topic I wanted to discuss.

How good are these vaccines in preventing Cervical Cancer?

Are there any risks in taking this vaccine?

Though they are marketed as cervical cancer vaccines, they only prevent the infection of few types of HPV that are responsible for about 70% of cervical cancers. The studies that were conducted were for a period of about 2 to 3 years only. No long-term study results are available yet. Also no studies were conducted in girls less than 16 years of age. The studies had shown that the Vaccine can prevent abnormal cell changes for 2 to 3 years, but long-term effectiveness is not known.

Cervical intra epithelial neoplasia (abnormal cell growth) is graded from 1 to 3. Grade 1 indicates active HPV infection and is not considered to be pre-cancerous; current guidelines discourage treatment of this condition. Grade 2 is treated in most women but is not considered as true marker of developing cancer, as up to 40 percent of such lesions regress spontaneously; current guidelines suggest that some young women with such lesions do not need treatment. Grade 3 cervical neoplasia has the lowest likelihood of regression and the strongest potential to become cancerous.

In the HPV vaccine trials not much efficacy was reported in Grade 3 disease. This was attributed to other types of HPV, [against which we do not have vaccines] taking over and producing Cancer.

Though 3 doses are currently recommended whether there is a need for booster dose is not known

In conclusion the overall efficacy is only about 17 to 20 %.

Even after taking the vaccine the Women should undergo routine screening and safe sex practices to get maximum benefits.

Although it was licensed for use in the United States in June 2006, the first phase 3 trials of the HPV vaccine with clinically relevant end points — cervical intraepithelial neoplasia grades 2 and 3 (CIN 2/3) — were not reported until May 2007,

Why the US FDA and CDC was in such a hurry to give approval to this vaccine?


The editorial in the New England Journal of Medicine [NEJM] said:

The vaccine was highly successful in reducing the incidence of precancerous cervical lesions caused by HPV-16 and HPV-18, but a number of critical questions remained unanswered.
For instance, will the vaccine ultimately prevent not only cervical lesions, but also cervical cancer and death?
 How long will protection conferred by the vaccine last?
Since most HPV infections are easily cleared by the immune system, how will vaccination affect natural immunity against HPV, and with what implications?
How will the vaccine affect preadolescent girls, given that the only trials conducted in this cohort have been on the immune response? ......

.....In the meantime, there has been pressure on policymakers worldwide to introduce the HPV vaccine in national or statewide vaccination programs. How can policymakers make rational choices about the introduction of medical interventions that might do good in the future, but for which evidence is insufficient, especially since we will not know for many years whether the intervention will work or — in the worst case — do harm?

....... serious questions regarding the overall effectiveness of the vaccine in the protection against cervical cancer remained to be answered, and more long-term studies were called for before large-scale vaccination programs could be recommended.

Is the vaccine safe?

.Even though most of the reported adverse events were not serious, there were some reports of hypersensitivity reactions including anaphylaxis, Guillain-Barré syndrome, transverse myelitis, pancreatitis, and venous thromboembolic events. The editorial in the JAMA [Journal of American Medical Association] says, "it is also difficult to conclude that a serious event is not caused by the vaccine". That means the safety is not fully assured.



Should I recommend the HPV Vaccine?

The JAMA editorial says:

When do physicians know enough about the beneficial effects of a new medical intervention to start recommending or using it? When is the available information about harmful adverse effects sufficient to conclude that the risks outweigh the potential benefits? If in doubt, should physicians err on the side of caution or on the side of hope? These questions are at the core of all medical decision making. It is a complicated process because medical knowledge is typically incomplete and ambiguous. It is especially complex to make decisions about whether to use drugs that may prevent disease in the future, particularly when these drugs are given to otherwise healthy individuals. Vaccines are examples of such drugs, and the human papillomavirus (HPV) vaccine is a case in point.


........Whether a risk is worth taking depends not only on the absolute risk, but on the relationship between the potential risk and the potential benefit. If the potential benefits are substantial, most individuals would be willing to accept the risks. But the net benefit of the HPV vaccine to a woman is uncertain. Even if persistently infected with HPV, a woman most likely will not develop cancer if she is regularly screened. So rationally she should be willing to accept only a small risk of harmful effects from the vaccine.


When weighing evidence about risks and benefits, it is also appropriate to ask who takes the risk, and who gets the benefit. Patients and the public logically expect that only medical and scientific evidence is put on the balance. If other matters weigh in, such as profit for a company or financial or professional gains for physicians or groups of physicians, the balance is easily skewed. The balance will also tilt if the adverse events are not calculated correctly.


My conclusion is like this.

I will not recommend HPV Vaccine with the present available scientific evidence due to the fact that the efficacy in preventing invasive cervical cancer is not much and there is a small but considerable risk of adverse events.
Even though India reports more than 70000 deaths yearly due to cervical cancer,this coslty vaccine [around 10000 Rs for 3 shots] is highly unlikely to make any change in incidence of Cervical cancer in India due low efficacy and prohibitive cost.

Links and references
NEJM editorial
JAMA editorial
Controversy on cancer vaccine
more on cervical cancer

Life style changes in the New Year

I do not practice what I preach.

I preach to my patients about

'the importance of regular exercise in maintaining good health'.

I preach about

'importance of eating less fatty food'

I preach about

'reducing weight to reach an ideal BMI'

I preach about

'eating plenty of fruits and vegetables'

I preach about

'cutting down on snacks'.



I do not practice what I preach.



I never do regular exercise. Never cut down on fatty foods. Eat fruits rarely but snacks frequently.

May be it is time for me to practice what I preach starting from this year.I aim to achieve a BMI of 25 by the end of this year. Currently it is 28.4.

Let me try my best.

To calculate your BMI and to know more about a healthy BMI click the link below.
http://www.nhlbisupport.com/bmi/bmi-m.htm

A very 'Positive' news from Pakistan

Cricket is the national sport in Pakistan as it is in India, but what makes the First Positive Cricket Team stand out from all the other Karachi-based clubs is that its members are all HIV positive.


The team was put together a year ago by the Pakistan Society, an NGO working for the rights of people living with HIV. They played -- and won -- their first match in August, and haven't looked back.

Dr. Saleem Azam, president of the Pakistan Society, told CNN, "Every time they play the players have a boost physically, emotionally and psychologically, and they feel a lot better."

Azam says that there is a considerable stigma in Pakistan surrounding HIV/AIDS and he hopes the team can help combat discrimination towards HIV sufferers.

"People assume the team must be very sick-looking, like walking skeletons, but when they see them playing and winning matches they have to think again," said Azam.

"We've given them a very strong message that having HIV does not mean you must retire from life and become helpless. You can have HIV and live a very happy life if you take your antiretroviral treatment regularly.
 When the team won handsomely, leaving their opponents and the fans amazed that HIV-positive players could be so active - one of the team members was asked whether antiretroviral medication was also a form of performance-enhancing drugs.



"The stigma is the worst consequence of this illness, so it will be the greatest service to people with HIV if we are able to help them overcome this stigma. The change is coming, but it's very, very slow."

While changing attitudes takes time, Azam says the team has already built bridges between the players and their estranged families. He told CNN that some players who had been ostracized by their families were now back in contact with them, with one family requesting to travel to matches with the team.




First Positive has already played a match in Hyderabad, about 200 km (125 miles) from Karachi, and next month they will take to the road for two more matches, which will see them spread their message elsewhere in the country.

"This is how the team will be known the country over," said Azam.

"People will come to know more and more about the team, and I hope eventually they will be successful in combating this stigma and discrimination."

Abdul Lateef is captain of the FPCT. He contracted HIV six years ago and told CNN that the team is helping to change others' attitudes towards people with HIV.

"We are reaching the minds of the people," he said.

"Everybody thinks there are things that HIV positive people cannot do. We have shown we can play and we have proved to everybody we can do anything they can do."

We are thankful that the authorities were so cooperative with us, and provided us with the space that was needed for the match without any discriminatory attitude. Rather, their attitude was positive and encouraging," said Azhar Hussain Magsi, a manager at the Pakistan Society.


"More matches are scheduled to take place all over Pakistan in the coming weeks ... We are also having talks with other NGOs in India, and look forward to having an international HIV-positive cricket match.

Having personally witnessed the wonders that anti retro viral therapy can produce in many patients, I cannot think a better way of illustrating the fact that HIV/AIDS is treatable and HIV positive patients are as human as we all are than the site of a 'Positive' cricket team winning a match against the 'negative' team on the cricket field.


An India-Pakistan cricket match between HIV positive players!!!

That will be a great event.

adapted from
CNN
AIDS Portal

World AIDS Day 2009.A statistical update

Another World AIDS Day is here.Let me update you with the current statistics and trends.
New figures released by the World Health Organization and UNAIDS estimate the number of new HIV infections have declined each year by about 17% from 2001 to 2008.
The number of new infections in sub-Saharan Africa is approximately 15% lower, which is about 400,000 fewer infections in 2008.
In East Asia new HIV infections declined by nearly 25% and in South and South East Asia by 10% in the same time period.
In Eastern Europe, after a dramatic increase in new infections among injecting drug users, the epidemic has leveled off considerably.
However, in some countries there are signs that new HIV infections are rising again.


But for every five people infected, only two start treatment.
The UN report noted about 4 million people were receiving AIDS drugs at the end of 2008, compared with 3 million the previous year. Nonetheless, an additional 5 million people need treatment and are not receiving it.

Number of people living with HIV in 2008


Total 33.4 million [31.1 million–35.8 million]

Adults 31.3 million [29.2 million–33.7 million]

Women 15.7 million [14.2 million–17.2 million]

Children under 15 years 2.1 million [1.2 million–2.9 million]


People newly infected with HIV in 2008

Total 2.7 million [2.4 million–3.0 million]

Adults 2.3 million [2.0 million–2.5 million]

Children under 15 years 430 000 [240 000–610 000]

AIDS-related deaths in 2008

Total 2.0 million [1.7 million–2.4 million]

Adults 1.7 million [1.4 million–2.1 million]

Children under 15 years 280 000 [150 000–410 000]

There are more people living with HIV than ever before as people are living longer due to the beneficial effects of antiretroviral therapy and population growth.
However the number of AIDS-related deaths has declined by over 10% over the past five years as more people gained to access to the life saving treatment.
 UNAIDS and WHO estimate that since the availability of effective treatment in 1996, some 2.9 million lives have been saved.
 
Antiretroviral therapy has also made a significant impact in preventing new infections in children as more HIV- positive mothers gain access to treatment preventing them from transmitting the virus to their children. Around 200 000 new infections among children have been prevented since 2001.
 Indian Statistics
 There are 3 million persons in India living with HIV, equivalent to approximately 0.36 percent of the adult population. The revised national estimate reflects the availability of improved data rather than a substantial decrease in actual HIV prevalence in India.
 
The transmission route is still predominantly sexual (87.4 percent); other routes of transmission by order of proportion includes perinatal (4.7 percent), unsafe blood and blood products (1.7 percent), infected needles and syringes (1.8 percent)
and unspecified and other routes of transmission (4.1 percent)2.
 
In India also there is a declining trend in new infections in southern states and Maharashtra while the epidemic is yet to level in Northern States.
 
 
This year’s World AIDS Day theme of Universal Access and Human Rights, highlights the critical link between universal access to HIV prevention, treatment, care and support and respect for human rights in the response to the global AIDS epidemic. Without addressing human rights abuses, many of the populations most vulnerable to or living with HIV will lack access to prevention and treatment services.