What is hearing aid?

A hearing aid makes sounds louder (amplifies). While hearing aids may amplify some types of sounds more than others, at this time they cannot be made or programmed to amplify only one type of sound, such as a voice. Hearing aids do not restore normal hearing, but they may help people with hearing lose function and communicate more easily.

What should I do if I think I need a hearing aid?

If you think you have a hearing problem and are thinking about getting a hearing aid, see your doctor. If your doctor thinks you may need a hearing aid, another type of specialist (audiologist) can help determine what type of hearing aid will work best for you. The audiologist will pick a hearing aid based on the type and how much hearing loss you have and other factors. He or she can help you learn how to get the most out of your hearing aid. In general, it usually is better to wear hearing aids in both ears, even if the hearing loss in the ears is not equal.

You also need to consider cost. Hearing aids can be expensive, and they are not always covered by insurance. Be sure to ask about a return policy, in case you are not satisfied with the hearing aid, and any warranties.

What are the different types of hearing aids?

Hearing aids differ in how they look, their size, where they are placed in the ear, and how much they can amplify sounds. All hearing aids consist of:

• A microphone, to pick up sound.
• An amplifier, to make the sound louder.
• A speaker, to deliver the sound into the ear.
• Batteries, to power the hearing aid.

What Happens Inside the Body?

Once HIV enters the human body, it attaches itself to a White Blood Cell (WBC) called CD4. Also, called T4 cells, they are the main disease fighters of the body. Whenever there is an infection, CD4 cells lead the infection-fighting army of the body to protect it from falling sick. Damage of these cells, hence can affect a person's disease-fighting capability and general health.


After making a foothold on the CD4 cell, the virus injects its RNA into the cell. The RNA then gets attached to the DNA of the host cell and thus becomes part of the cell's genetic material. It is a virtual takeover of the cell. Using the cell's division mechanism, the virus now replicates and churns out hundreds of thousands of its own copies. These cells then enter the blood stream, get attached to other CD4 cells and continue replicating. As a result, the number of the virus in the blood rises and that of the CD4 cells declines.


Because of this process, immediately after infection, the viral load of an infected individual will be very high and the number of CD4, low. But, after a while, the body's immune system responds vigorously by producing more and more CD4 cells to fight the virus. Much of the virus gets removed from the blood. To fight the fast-replicating virus, as many as a billion CD4 cells are produced every day, but the virus too increases on a similar scale. The battle between the virus and the CD4 cells continues even as the infected person remains symptom-free.


But after a few years, which can last up to a decade or even more, when the number of the virus in the body rises to very high levels, the body's immune mechanism finds it difficult to carry on with the battle. The balance shifts in favour of the virus and the person becomes more susceptible to various infections. These infections are called Opportunistic Infections because they swarm the body using the opportunity of its low immunity. At this stage, the number of CD4 cells per millilitre of blood (called CD4 Count), which ranges between 500 to 1,500 in a healthy individual, falls below 200. The Viral Load, the quantity of the virus in the blood, will be very high at this stage.


Opportunistic infections are caused by bacteria, virus, fungi and parasites. Some of the common opportunistic infections that affect HIV positive persons are: Mycobacterium avium complex (MAC), Tuberculosis (TB), Salmonellosis, Bacillary Angiomatosis (all caused by bacteria); Cytomegalovirus (CMV), Viral hepatitis, Herpes, Human papillomavirus (HPV), Progressive multifocal leukoencephalopathy (PML) (caused by virus); Candidiasis, Cryptococcal meningitis (caused by fungus) and Pneumocystis Carinii pneumonia (PCP). Toxoplasmosis. Cryptosporidiosis (caused by parasites). HIV positive persons are also prone to cancers like Kaposi's sarcoma and lymphoma.

The Center for Disease Control (CDC), Atlanta has listed a series of diseases as AIDS-defining. When these diseases appear, it is a sign that the infected individual has entered the later stage of HIV infection and has started developing AIDS. The progression of HIV positive persons into the AIDS stage is highly individual. Some people can reach the AIDS stage in about five years, while some remain disease free for more than a decade. Measurement of the viral load and the CD4 count helps a doctor in assessing an infected person's health condition

How do some of the relevant rights apply?

To empower rights-holders to claim their rights, to protect human dignity and to prevent the transmission of HIV, the following rights should be protected so that people will come forward for HIV information, education and means of protection, and will be supported to avoid risky behaviour:

• Non-discrimination : protected against discrimination if seek help or are HIV+
• Right to privacy : protected against mandatory testing; HIV status kept confidential
• Right to liberty and freedom of movement : protected against imprisonment, segregation, or isolation in a special hospital ward
• Right to education/information : access to all HIV prevention education and information and sexual and reproductive health information and education
• Right to health : access to all health care prevention services, including for sexually transmitted infections, tuberculosis, voluntary counseling and testing, and to male and female condoms

Vulnerable populations

Depending on the legal and social situation and the nature of the epidemic in country, some groups may be more vulnerable to infection and impact because of their legal status or lack of human rights protection, e.g. women, children, minorities, indigenous people, poor people, migrant-workers, refugees, sex workers, people who use drugs, men having sex with men, and prisoners.

These groups should have equal access to HIV prevention information, education, and commodities, and to HIV care, support and anti-retroviral treatment; should not be subject to sexual violence or coercion, where applicable; and should be able to participate in the formulation and implementation of HIV and AIDS policies that affect them.

• Non-discrimination/equality before the law : same access as others to services
• Rights to education and health : same access to HIV prevention education and information, and health care services, including STI services and condoms
• Liberty , security of person and freedom from cruel, inhuman and degrading treatment : freedom from violence, including sexual violence, freedom from mandatory testing
• Right to participate in public life : participation in the formulation and implementation of HIV policy

For those living with HIV or otherwise affected by it, the following rights should be protected:

• Non-discrimination and equality before the law : right not to be mistreated on the basis of health status, i.e. HIV status
• Right to health : right not to be denied health care/treatment on the basis of HIV status
• Right to liberty and security of person : right not to be arrested and imprisoned on the basis of HIV status
• Right to marry and found a family , regardless of HIV status
• Right to education : right not to be thrown out of school on the basis of HIV status
• Right to work : right not to be fired on the basis of HIV status
• Right to social security, assistance and welfare : right not to be denied these benefits on the basis of HIV status
• Right to freedom of movement , regardless of HIV status
• Right to seek and enjoy asylum , regardless of HIV status

Human rights and HIV

The risk of HIV infection and its impact feeds on violations of human rights, including discrimination against women and marginalized groups such as sex workers, people who inject drugs and men who have sex with men. HIV also frequently begets human rights violations such as further discrimination and violence. Over the past decade the critical need for strengthening human rights to effectively respond to the epidemic and deal with its effects has become evermore clear. Protecting human rights and promoting public health are mutually reinforcing.

Several countries still have policies that interfere with the accessibility and effectiveness of HIV-related measures for prevention and care. Examples include laws criminalizing consensual sex between men, prohibiting condom and needle access for prisoners, and using residency status to restrict access to prevention and treatment services. At the same time, laws and regulations protecting people with HIV from discrimination are not enacted, or fully implemented or enforced.

Reforming laws and policies that are based in deeply-rooted social attitudes and norms such as gender inequality requires multisectoral collaboration. Although not sufficient to change social attitudes, legislation is important for addressing acts of discrimination. Civil society, including organizations of people living with HIV, as well as other parts of society, including police and justice systems, have a critical role to play. International organizations and donors can also play a positive role in support of local and national actors.

The protection of human rights, both of those vulnerable to infection and those already infected, is not only right, but also produces positive public health results against HIV. In particular, it has also become increasingly clear that:

• National and local responses will not work without the full engagement and participation of those affected by HIV, particularly people living with HIV.
• The human rights of women, young people and children must be protected if they are to avoid infection and withstand the impact of HIV.
• The human rights of marginalized groups (sex workers, people who use drugs, men who have sex with men, prisoners) must also be respected and fulfilled for the response to HIV to be effective.
• Supportive frameworks of policy and law are essential to effective HIV responses.

UNAIDS works to help enable States to meet their human rights obligations, and to empower individuals and communities to claim their rights in the context of the HIV epidemic.

Human Rights and Universal Access: What have Governments committed themselves to?

To ensure the full enjoyment of all human rights and fundamental freedoms by people living with HIV and members of vulnerable groups; promoting access to HIV education and information; full protection of confidentiality and informed consent; intensifying efforts to ensure a wide range of prevention programmes, including information, education and communication, aimed at reducing risk-taking behaviours and encouraging responsible sexual behaviour, including abstinence and fidelity; expanded access to essential commodities, including male and female condoms and sterile injecting equipment; harm-reduction efforts related to drug use; expanded access to voluntary and confidential counselling and testing; safe blood supplies; and early and effective treatment of sexually transmitted infections; developing strategies to combat stigma and social exclusion connected with the epidemic.

Living With HIV: How Children Are Making The Successful Transition Into Adulthood

Most of what we read and hear about HIV and AIDS is bad. It is a bleak landscape where good news is generally hard to find.

Let alone what is happening in sub-Saharan Africa and other parts of the world under siege from this virus, the UK too is grappling with increasing health challenges from the HIV/AIDS epidemic.

The National AIDS Trust says the UK will have 100,000 people living with HIV by 2010 and failure of investment in HIV prevention and education is putting thousands at risk.

But, tough as it is to contract HIV as an adult, how much thought is given to those who have the virus at birth? As a child living with HIV in Britain today, how do you face the challenge and stigma of being HIV positive through no fault or direct action of your own? And how do you move forward into adulthood carrying such a responsibility?

In the heart of London, there is a very special clinic which is helping HIV positive adolescents from all over the country move through this journey from childhood to adulthood. The clinic, at St Mary's Hospital in Padding ton, is simply known as the '900'. Its central focus is to manage the successful passage of HIV positive kids from childhood to adulthood through multidisciplinary care.

Children are typically expected to move from pediatric to adult health services between the ages of 16 and 18. This is traditionally acknowledged amongst health professionals as a complex time to turn children over to adult care, especially for those with chronic diseases such as cystic fibrosis, diabetes and heart problems, which used to have high mortality rates in childhood. For kids who are HIV positive, the 900 aims to make this transition as seamless and successful as possible, and it is a UK first in shaping a new approach to the treatment and management of HIV.

"There is widespread recognition that the transfer from pediatric to adult services has been very poorly managed in the past. Often when this transfer has occurred, the level of care has deteriorated. Now there is increasing evidence that shows a proper transition process with shared paediatric and adult appointments can really help," says Caroline Foster, a paediatrician specialising in adolescent HIV, who helps manage the 900 clinic.

St Mary's, part of the Imperial College Healthcare NHS Trust, runs the largest pediatric clinic for kids born with HIV in the UK. It currently treats around 250 children, many of whom come to the clinic from considerable distances with shared care established with district general hospitals, allowing both the sharing of clinical care, expertise and education.

The total number of children known to be living with HIV in the UK and Ireland is estimated at around 1,400 but it is London which has the largest numbers. The average age in the paediatric clinic is 10, and there are now up to 50 young people who are aged 16 and above.

Now that virtually every pregnant woman takes up the routine antenatal HIV test, and if found to be infected can then take up interventions to prevent her baby becoming infected, and children with HIV are surviving thanks to combination antiresonator therapy, the median age of children with HIV is going up, thus generating the increasing need for adolescent care and care as young adults, according to Foster.

"To fulfill their potential, these children now need both medical and psychosocial help. Thus, typical treatment will involve anti retro viral drugs to suppress the virus and also support with problems that tend to come in the teenage years, for example in relationships with friends and family members especially, as this is very much a family disease," she says.

Problems for young people with HIV range from having to live with a chronic disease, adhering to medication which may cause side effects such as lipodystrophy which can be unsightly, as well as psychosocial issues such as the death or ill health of family members and the complex issues of negotiating relationships and your first sexual experiences with HIV. There is also the ever present issue of disclosure, as HIV remains a stigmatizing disease, with at least one example of the bullying on Facebook of a young girl who chose to come out.

Whilst these problems cannot be underestimated, there is good news too and Foster is anxious to make the point. "Four of the young women in this clinic have now had their own babies who are HIV negative and this is great news, because teenagers need to adhere to their treatment to make this happen. I think now we can say that there is a wave of young people born with HIV who are surviving on treatment, transitioning, moving into adult services, getting through school to university and who are fully engaged in getting on with their lives."

One cannot underestimate the issues that young people born with HIV and living in the UK have to deal with. But these issues are relative. In Africa, without treatment, half of kids born HIV positive will be dead by their third birthday.

Dosing and drug formulations in children

The dose of antiretroviral drugs given to children is generally based on either weight or body surface area. As children’s bodies are constantly changing, drug doses need to be altered to make sure that a child is not given too much, or too little, of a drug. Health care workers also need to take into account that children under the age of six metabolite drugs faster than adults, so even after adjusting for body weight, they may need to be given higher quantities of ARVs to achieve the same effect that the drugs would have in adults. Information about specific drugs is often limited, and drug manufacturers and expert guidelines use a variety of ways to calculate doses of pediatric ARVs, so there is no uniform dosing system to follow.
Because of the complex nature of pediatric dosing, under- or over-dosing can be a serious risk. Dosing is further complicated by the variety of forms that ARVs may take when provided to children, all of which require different measurements. Infants who are too young to swallow tablets ideally need to be provided with these drugs in the form of syrups or powders, but these formulations are expensive and often impractical. Some syrups need to be refrigerated after opening, which requires a reliable electricity supply, and powders need to be mixed with water, which may be unfeasible in areas where clean drinking water is not regularly available. In addition, the unpleasant taste of syrups and powders can make it difficult for children to take their ARVs every day.
An encouraging development is the relatively recent availability of fixed-dose combination therapies (FDCs), which combine multiple ARVs into a single tablet, for children. Tablets consisting of lamivudine, stavudine and nevirapine have been supplied by the Clinton HIV/AIDS Initiative (CHAI), in conjunction with drug purchase facility, UNITAID, to children in 26 nations. In these countries CHAI’s monthly pediatric treatment formerly consisted of 12 bottles of liquid. For those children who can now access FDCs, only a small container of tablets is needed, making the therapy easier to store, transport and administer.
In areas where there is a lack of affordable pediatric ARV formulations, clinicians often have no choice but to divide adult fixed-dose combination drugs into measures appropriate for children. There is evidence that dividing tablets carries a risk of under- or over-dosing but equally, a significant 2006 study of eight countries concluded that the use of divided adult FDCs can achieve successful and satisfactory results in children. The World Health Organisation supports this practice in situations where no appropriate pediatric medications are available.

HIV patients with mental health problems live just as long, says Australian study

HIV-positive individuals with mental health disorders survive just as long as HIV-positive people with good mental health, according to an Australian study published in the May edition of HIV Medicine. The investigators established, however, that patients with mental health problems took more antiretroviral drugs and spent more time in hospital than patients without mental health difficulties. Appropriate use of antiretroviral therapy could, they suggest, not only improve the health of patients with both HIV and mental health problems, but also reduce their use of healthcare resources.

Mental health disorders are common in people with HIV. Investigators from Melbourne, Australia, wished to determine the prevalence and impact of mental disorders in their clinic population between 1984 and 2000. They hypothesised that individuals with mental health problems would have a worse outcome, with poorer treatment outcome, reduced response to antiretroviral therapy, and increased mortality when compared to patients with no recorded mental health disorders.

The investigators performed a retrospective analysis including all 2,981 patients who received care for HIV at the Alfred Hospital. They cross-referenced this population with the VPCR database of mental health patients and found that 525 individuals matched.

Substance abuse was the most common psychiatric disorder seen in these individuals (17%), followed by affective disorders (9%) and personality disorders (2%). In 47% of cases, the cause of the mental health problem was unknown.

In a third of individuals, the mental health disorder pre-dated diagnosis with HIV. The investigators also observed that there were some slight differences in the demographics of patients recorded on the VPCR database and those of Alfred Hospital cohort. In particular, VPCR patients were less likely to be gay (58% versus 70%) and more likely to report injecting drug use as their HIV risk activity (24% versus 7%).

The investigators noted that 31% of individuals with mental health disorders received treatment with potent antiretroviral therapy after 1996 compared to 26% of individuals with no recorded mental health problems. They also noted that patients on the VPCR database used more antiretroviral drugs (median 6.4) than individuals with good mental health (median 5.5) and hypothesise that this was due to adherence problems or the capacity for some anti-HIV drugs, such as efavirenz (Sustiva) to exacerbate pre-existing mental health difficulties.

A third of individuals with mental health problems were hospitalised compared to 23% of patients with no recorded mental health disorders. The investigators also noted that there were differences in the reasons for hospitalisation between the two groups of patients, with patients with mental health problems more likely to be hospitalised because of infections (29% versus 20%), for non-infectious conditions such as liver problems (28% versus 19%) and for mental health reasons (18% versus 8%). Factors independently associated with an increased risk of hospitalisation were mental health problems (p < 0 .001), a prior AIDS-defining illness (p < 0.001) and receiving HIV treatment prior to 1986 (p = 0.001).

The investigators then looked to see if there was any relationship between a recorded mental health disorder and an increased risk of death. They found no difference in survival between patients in the general Alfred Hospital cohort and those on the VPCR database.

“Patients with psychiatric disorders are able to benefit from highly active antiretroviral therapy”, write the investigators. However, they note that their study was limited by its retrospective design. They conclude, “enhancing awareness and improving treatment in those with both HIV and mental health disorders may potentially improve quality of life for these patients but may also reduce unnecessary health care usage.”