AIDS In The USA

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What is Viagra?

Viagra (sildenafil citrate) is a prescription medicine taken by mouth for the treatment of erectile dysfunction (ED) in men. ED is a condition everywhere the penis does not harden and enlarge when a man is sexually excited, or when he cannot keep an manufacture. Viagra may help a man with ED get and keep an manufacture when he is sexually excited. Viagra is only for men, not for women and children, and must be used only under a doctor’s care.
Know what to expect
- You will not get an instant manufacture. You must be aroused for viagra to work
- Viagra usually facility in about 30 minutes
- Viagra facility for 4 hours, so you can take your time
- After sex, your manufacture will go away
- To get the fastest results, take viagra on an unfilled stomach or after intake a low-stout meal

What does Viagra do?

As you’ve probably heard, Viagra (Sildenafil) is used to treat impotence in men who either can’t have or can’t maintain erections. On the market since March 1998, it’s one of the most commercially thriving drugs ever launched, with millions of prescriptions filled at a cost of more than $ 1 billion during the first year alone. It even has the blessing of the Vatican, on the ground that it can strengthen families.
Just as vital, here’s what Viagra can’t do. It isn’t an aphrodisiac; it can’t get you aroused when you’re not interested. And it’s not a performance-enhancer. If you’re healthy, Viagra won’t give you a quicker or harder manufacture or help you last longer. In fact, in healthy men it can even cause a painful, long-lasting manufacture (a condition called priapism) that may lead to impotence if it isn’t treated quickly.

What happens if I miss a dose?

Viagra is used as needed, so you are not likely to miss a dose.
If you miss a dose of Revatio, take the missed dose as soon as you remember. If it is very nearly time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

Erectile dysfunction (ED or (male) impotence) is a sexual dysfunction characterized by the inability to develop or maintain an manufacture of the penis. There are various underlying causes, such as cardiovascular leakage and diabetes, many of which are medically treatable.

Erectile dysfunction, tied closely as it is to cultural notions of potency, success and masculinity, can have devastating psychological consequences including feelings of shame, loss or inadequacy; often unnecessary since in most cases the topic can be helped. There is a strong culture of silence and inability to discuss the topic. In fact around 1 in 10 men will experience recurring impotence problems at some point in their lives.

The causes of erectile dysfunction may be physiological or psychological. Physiologically, manufacture is a hydraulic mechanism based upon blood entering and being retained in the penis, and there are various ways in which this can be impeded, most of which are amenable to treatment. Psychological impotence is everywhere manufacture or penetration fails due to view or feelings (psychological reasons) rather than physical impossibility; this can often be helped. Notably in psychological impotence there is a very strong placebo look

Viagra F.A.Q.

1. What is viagra for?
Viagra is approved for the treatment of men who have difficulty having and maintaining an manufacture (impotence).

2. How much does viagra cost?
The FDA has no input into or legal control over the pricing of any drug product. Some companies sell viagra far above what most others charge.
The more you buy, the less the cost per does will be. If you have tried viagra and know it facility for you, buying in larger quantities is recommended. If you have never used viagra, you should get a smaller amount to see if it facility for you.

3. Is viagra available to pharmacies?
Viagra is available to most offline and online pharmacies. The choice of availability is completely up to the company marketing the product, Pfizer, Inc. For further information contact your pharmacist.

4. Does insurance cover the cost of viagra?
The FDA has no input into or legal control over whether an insurance company does or does not cover the cost of drugs. Some insurance plans to cover viagra, others don’t. Delight call you insurance company if you have questions about whether your particular insurance provider will cover the cost of this product for you.

5. How do I take viagra?
Viagra is taken orally (most once per twenty-four hour period) about one hour previous to sexual activity. For more detailed information consult with your health care provider.

6. How does viagra work?
An manufacture is the result of an increase in blood flow into certain internal areas of the penis. Viagra facility by enhancing the effects of one of the chemicals the body normally releases into the penis during sexual arousal. This allows an increase of blood flow into the penis.

7. How long does it take for viagra to be effective?
When consumed orally on an unfilled stomach, most observed plasma concentrations are reached within 30 to 120 minutes (60 minutes is average for the most amount to be seen in the blood stream).
The effects of viagra can last up to 4 hours, but the response at 4 hours is less than it was 2 hours after consumption. When viagra is taken with a high stout meal, the rate of effectiveness is reduced.

8. Can viagra be used with other treatment for impotence?
The protection and effectiveness of viagra when used with other treatment for impotence has not been studied. The use of such treatments in amalgamation with viagra is not recommended at present.

9. Are there any side effects with viagra?
As with any drug products, there are side effects of the product in some people. The most commonly reported side effects in patients treated with viagra are: headache, flushing, stomach ache, urinary tract infection, diarrhea, faintness, rash, and mild and fleeting visual changes (color perception changes, light perception changes, and blurred vision). Stomach ache and abnormal vision were more common at 100 mg than at lower doses.

10.What if I am taking other drugs?
Always discuss with your health care practitioner ALL of the medications you are taking (prescription and over-the-counter). In that way, you can receive the best advice for your own situation. At present, viagra is not recommended for people taking commonly prescribed small- and long-acting nitrates because the amalgamation may lower blood pressure.

PATIENT INFORMATION

VIAGRA
25 mg, 50 mg or 100 mg tablets
Read this information carefully previous to you start taking Viagra.
This medicine is for men only.
Previous to using this medicine delight try out carefully if this is the medicine your doctor has prescribed. Verify if the name and address on the package and the name of the medicine are exactly the same as you ordered.
This information may change. Therefore, read the leaflet again each time you get more of this medicine.

In this leaflet:
1. What is viagra
2. Previous to you take viagra
3. How to take viagra
4. Possible side effects
5. Storing viagra

1.WHAT IS VIAGRA ?
• The active substance of viagra is sildenafil. Each filmcoated tablet contains 25 mg, 50 mg or 100 mg of sildenafil (as the citrate).
• The other ingredients are: Tablet core: microcrystalline bran, calcium hydrogen phosphate (anhydrous), croscarmellose sodium, magnesium stearate. Film coat: hypromellose, titanium dioxide (E171), lactose, triacetin, indigo carmine aluminium lake (E132).

Viagra belongs to a assemble of medicines called phosphodiesterase type 5 inhibitors. It facility by helping to relax the blood vessels in your penis, allowing blood to flow into your penis when you get sexually excited. Viagra will only help you to get an manufacture if you are sexually stimulated. You should not take viagra if you do not have erectile dysfunction. You should not take viagra if you are a woman.
Viagra is a treatment for men with erectile dysfunction, sometimes known as impotence. This is when a man cannot get, or keep a hard, erect penis suitable for sexual activity.

2. BEFORE YOU TAKE VIAGRA
Do not take VIAGRA :
• If you are taking medicines containing nitrates, or nitric oxide donors such as amyl nitrite (“poppers”). These medicines are often given for relief of angina pectoris (or “chest pain”). Viagra can cause a serious increase in the effects of these medicines. Tell your doctor if you are taking any of these medicines. If you are not certain, question your doctor or pharmacist.
• If you have ever had an allergic reaction to viagra or any other ingredient listed above. An allergic reaction can be a rash, itching, a swollen face, swollen lips or shortness of breath. If this has ever happened to you, tell your doctor.
• If you have a severe heart or liver problem.
• If you have just had a stroke or a heart attack, or if you have low blood pressure.
• If you have certain rare inherited eye diseases (such as retinitis pigmentosa).

Take special care with VIAGRA
Delight tell your doctor
• if you have sickle cell anaemia (an abnormality of red blood cells), leukaemia (cancer of blood cells), multiple myeloma (cancer of bone marrow) or any disease or deformity of your penis. These conditions may require special care when taking medicines for erectile dysfunction.
• if you have problems with your heart. In that case your doctor should carefully try out whether your heart can take the additional strain of having sex.
• if you currently have a stomach ulcer, or a bleeding disorder (such as haemophilia).

You should not use viagra with any other treatment for erectile dysfunction. Viagra should not be given to children under the age of 18.
Elderly patients over 65 years of age: your first dose of viagra should be adjusted to a lower dosage. Patients with kidney or liver problems: you should tell your doctor if you have kidney or liver problems. Your doctor may choose if your dose should be adjusted.

Using viagra with food and drink: When viagra is taken with food, it may take a small longer for viagra to work.

Pregnancy and breast feeding: Viagra is not indicated for women.

Driving and using machines: Viagra can cause faintness and effects on vision. You should be attentive of how you react to viagra previous to you drive or operate machinery.

Using other medicines: Delight inform your doctor or pharmacist if you are taking or have taken just other medicines, also persons not prescribed.
Viagra tablets may interfere with some medicines, especially persons used to treat chest pain. In the event of a medical emergency, you should tell anyone treating your condition that you have taken viagra. Do not take viagra with other medicines unless your doctor tells you that you can.
Viagra may cause a serious increase in the effects of medicines called nitrates, and nitric oxide donors such as amyl nitrite (“poppers”). These are often used for the relief of angina pectoris (or “chest pain”). You should not take viagra if you are taking these medicines.
If you are taking protease inhibitors, such as for the treatment of HIV, your doctor may start you on the lowest dose (25 mg) of viagra.

3. HOW TO TAKE VIAGRA
The usual dosage of viagra is 50 mg.
If you have the impression that the look of viagra is too strong or too weak, tell your doctor. You should take viagra about one hour previous to sexual activity. Swallow the tablet whole with some fill up.
Viagra will only help you to get an manufacture if you are sexually stimulated. It will not give you an manufacture if you are not sexually stimulated. The amount of time viagra takes to work varies from person to person, but it normally takes between half an hour and one hour. You may find that viagra takes longer to work if you take it with a heavy meal.
Drinking alcohol can temporarily impair the ability to get an manufacture. To get the most benefit from your medicine, you are advised not to drink generous amounts of alcohol previous to taking viagra.

If viagra does not help you to get an manufacture or if your manufacture does not last long enough for you to complete sexual intercourse you should tell your doctor. You should not use viagra more than once a day. If you take more viagrathan you should: A dose above 100 mg does not increase the efficacy. But, it will result in an increase in undesirable effects and their severity. You should not take more tablets than your doctor tells you to. If you take more tablets than you have been told to take contact your doctor.

4. POSSIBLE SIDE EFFECTS
Like all medicines, viagra can have side effects. These effects are normally mild to moderate in nature.
The most common undesirable effects are headache and facial flushing. Less commonly reported undesirable effects are indigestion, faintness, stuffy nose and effects on vision (including colour tinge to vision, augmented brightness of light or blurred vision).
Rarely, bloodshot eyes, eye pain have been reported.
Muscle aches can occur if viagra is taken more frequently than once a day.

Rarely, prolonged and sometimes painful erections have been reported after taking viagra. If you have such an manufacture which lasts continuously for more than 4 hours, you should contact a doctor immediately.
Rarely, hypersensitivity reactions (including skin rashes) have been reported.

5. STORING VIAGRA
Keep out of the reach and sight of children.
Store in a dry place below 30 °C. Do not use after the expiry date stated.
Return any expired and unused medicine to the pharmacy for proper disposal.

Early a Food Business

This guide is for prospective operators of food enterprises (food establishments, retail food stores, food warehouses, and food processors) desiring to open a food business in either their local city, county or state jurisdiction. This is a general overview and may not be all inclusive of the codes and ordinances in your locality.  It is excellent to note that though this document will more than likely cover most if not all requirements for early a food business in your jurisdiction, it would be in your best appeal to familiarize yourself with the codes and regulations of your local city, county and/or state. 

Operating Permits – Food Enterprises
A Food Establishment application can be obtained at your local city or county health department.  If you plot to manufacture foods and package for retail sale you may be required to obtain a food manufacturer’s license from your state regulatory agency.  If you plot to distribute your product outside of your state lines a federal license may also have to be obtained.  It is recommended that you submit a fully completed application and fees at least one month prior to your anticipated notch date.  This gives the local authority the needed lead time to process it and schedule any needed pre-notch inspections.  Again, make sure that you provide ALL information required on the application.  Incomplete applications may delay your approval.
Food permits are generally in look for one year from the date of issue and are renewable each year thereafter when the appropriate fee is paid and as long as the establishment remains in compliance with applicable Health codes and regulations.
Home preparation of food for public consumption is prohibited. All food that is to be consumed by the public, whether free or for buy must be prepared at a permitted establishment that is inspected by a federal, state, or local Health Authority.

Food Establishment Fee: Food establishment fees are variable depending on jurisdiction. Contact your local health authority to inquire about permitting fees.

NOTE: Larger establishments that have multiple food service operations on site may need to obtain a health permit for each operation.  A separate application and fees may need to be submitted for each operation.

Food Enterprise Pre-Notch Processes
When early a Food Enterprise business you may be required to go through either or both A) a change of ownership inspection or B) a plot review process. Read through options A & B below to determine which best fits your situation. Contact your local health authority if you need help in building that determination.

A) Change of Ownership Inspection Process-

Previous to notch for business you may be required to go through a change of ownership inspection.  This inspection verifies your establishment complies with current regulations and that clearance to occupy the site has been granted by your city or county.  This inspection may incur a fee and the fee for this inspection will more than likely be required to be paid previous to the inspector conducts the inspection.   If applicable, a request for a Change of Ownership application should be available at the offices of your local city or county health authority.  Again, to expedite your request, a fully completed application must be submitted.  After submitting the application; call to schedule the inspection with your inspector.  If the establishment doesn’t comply with current regulations you will be required to bring it up to code previous to your operating permit is approved. Prospective business owners, if available, it would be in your best appeal to request a change of ownership inspection previous to finalizing the sale. This gives the prospective business owner a heads up on any items that may be required for the establishment to be in compliance with local city or county codes. Under no circumstances may you start operations without approval from the local city or county health authority.  Legal charges may be filed against you if you do.

B) Food Establishment Plot Review Process¬

A plot review will more than likely be required for any newly built business or in the event of an extensive remodel of an existing business.  NOTE: This will also more than likely require a completed application and fees be paid in peacefulness to initiate this process.

A Plot Review is required whenever a building is constructed or substantially remodeled to be a food enterprise, whenever a substantial change is made to an existing food facility or may be required if a plumbing permit, building permit, or other construction permit is required by the local city or county enhancement offices. 
The Plot Review Application, including proposed menu, Fees, and 1 or more sets of building plans all may be required to be submitted as a package. Review all forms thoroughly to make sure accuracy of information provided. Incomplete or inaccurate applications could delay your plot review.  The Plot Review Application should be available at the offices of your local city or county Health Authority. Upon approval, the plans are stamped by the Health Authority and the person submitting the plans will be called to pick them up.
Submit building plans after the type of food operation and menu has been determined and after receiving Building approval from your local city or county enhancement offices. The building plans should be drawn to extent with most plans drawn in a extent of ¼” = 1Ft. and detail the layout of the kitchen, dining area, restrooms, storage space areas, break room, wait stations and bar. The plans are to include a materials list of specifications for all floors, walls, and ceilings. 
Certificate of Occupancy
All Food Enterprises will more than likely be required to have a Certificate of Occupancy (CO). A CO is issued after the Building and Health Officials inspect the building and find no violations of the Building or Health Codes during new construction and/or a remodel. The CO will also state the use for which the building will be used. The CO Inspection is usually required prior to getting final health approval but in some cases not only may a preliminary CO inspection be required prior to receiving your final health approval but a lesser (final) CO inspection may be required by your building inspector previous to your Operating Permit is approved.  Inquire with your local health authority and building inspectors to see what process is required.  NOTE: Contact the building inspectors at least 7 days prior to the time you are ready to schedule your inspection.  This should insure that you get a timely response.
Permit Approval
Once you have completed the pre-notch processes and your Building and Health Inspectors have approved your operating permit, you may open for business. Under no circumstances may you start operations without approval from both the Building and Health Inspectors. Legal charges may be filed against you if you do.
Other Approvals
Building Permits: Plans may need to be submitted for a Commercial Plot Review.  If required, contact your local Building or Enhancement Services Office to schedule this review and to obtain a building permit.
Industrial Waste: If you are taking over a previous business and varying the type of operation, make sure the grease trap meets the requirements for your new operation.  For model, when a “sandwich shop” becomes a “fried chicken” place, the existing grease trap may need to be modified. Contact your local industrial waste inspector to ascertain if any changes need to be made to the existing system or to evaluate your engineered designs if your plans require the installation of an on-site septic system.  
Fire Inspections: Building Inspectors are concerned with grease-laden vapors and proper hood protection in food facilities. All cooking equipment must be installed under an approved hood system.  In addition, establishments in excess of 5,000 sq. ft. are required to provide a sprinkler system. Establishments with an occupancy load in excess of 50 people are required to provide fire alarms. Call your local building inspector, fire inspector or fire marshal to evaluate plans or to schedule a site inspection.

What to place in a plot Review

Include and Identify the following on your Building Plans
? Major pieces of equipment
Refrigerator/freezer units  
Vent-hood  
Ice machines/bins/dispensers
Steamers    
Microwaves  
Warming Drawers
Stoves    
Prep tables  
Ice Cream Dispenser
Ovens     
Dish Machines 
Beverage Station/dispenser
Grills     
Mixers   
Liquidizer Station
Fryers     
Food Processors Salad/Food Buffets

? Sinks
Hand sinks (food prep areas • ware-washing area • restrooms)   Ware washing sinks Service Sink/Mop sink/curbed floor sink      Food Prep Sink
? Dumpster
? Grease Barrel
? Chemical Storage space areas
? Mop drying area
? Employee area for belongings
? Dry food storage space area
? Doors
? Mechanical ventilation in restrooms
? Outdoor food prep areas (bars/wait station/BBQ)
? Grease trap size and place
? Fill up Wells
? Underground and overhead sewer and waste lines
? On Site Dirt Facility

Health Code Plot Notes
1) Refrigeration All chilled units are to hold foods at or below 41°F.
2) Restrooms (two are normally required). If the establishment has only carry-out or seats for less than 20 people, and less than 10 employees, then only one employee restroom may be allowed. Two restrooms may be required if alcohol is served on the premises or more than 20 seats are provided.  Each restroom must have a hand sink with hot (at least 100°F) and cold fill up, mechanical air ventilation to the outside, and a solid, self-finishing door. Restrooms may not open directly into a kitchen. The total number of restrooms for a Childcare facility is needy on the “minimum standards” of the Texas. Dept. of Family and Protective Services (834-3195) as it relates to Childcare.
3) Sinks
A. Service Sink/Mop Sink/Curbed Floor sink: At least one of these must be available for mop washing and disposal of mop fill up in an approved waste fill up disposal system.  A drying rack is required for mops to air dry. This sink must be provided with a backflow preventer on any threaded hose bib to care for the fill up supply.  Note: the mop sink may be located in a different area of the building than the kitchen.
B. Hand washing sinks: Shall be located to allocate convenient use by employees in food preparation, food dispensing, ware wash areas, and any wait station everywhere ice is dispensed, bar area or in a walk-in everywhere meat is cut or trimmed.  At least one hand sink will be required; additional, separate hand sinks may also be required. Small kitchens with food prep and ware washing in close proximity may be allowed to use one hand sink to serve both activities.  Other hand sinks must be associated with restrooms. Provide at least 12” tall splashguards if a hand sink is located near food prep, open food, ice, or clean food contact surfaces.  Otherwise, the hand sink must have at least 18” lateral separation from these. A sign or poster that notifies food employees to wash their hands shall be provided to all hand washing sinks and be clearly visible. A small, swinging door (as in a bar area) could separate a hand sink from a work area, otherwise no doors separating hand sink from work areas.
Each sink must be supplied with hot (100°F) and cold fill up, soap and disposable towels. Childcare facilities must have hot fill up in the diaper varying area and kitchen.  If plans do not provide ample hand sinks to meet the requirements of the establishment you will be questioned to provide a revised plot with additional hand sinks.

C. Ware Wash Area:  A commercial dishwasher or 3 compartment sink is required in most cases. Dish machines must be able to effectively disinfect all equipment and utensils. They must dispense a chemical sanitizer or provide a final dab down of at least 180° F. (release, stationary rack machines are required to reach 165° in the disinfect cycle). Test strips are required. Above-the-counter dish machines are required to have Type II vent-hood.
Ware washing sinks shall be of ample size to immerse the largest piece of equipment. Cold and hot (100°F minimum) fill up under pressure delivered through a mixing valve shall be provided. Provide at least 2 vital drain boards or 1 vital drain board and a mobile dish cart. Drying racks or shelves will aid in adequately air drying all produce. Facilities with very limited ware washing and using disposable containers may request a variance to install a 2 compartment sink (model: convenience store). These sinks are required to have a drain board. The sinks must have an indirect connection to the sanitary sewer (at least a one inch air gap). This includes all food prep sinks and ware wash sinks.
4) Ceiling Construction: Ceilings over open food, ice, soda fountains, ware washing, restrooms and bars must meet construction criteria and be charming, durable, nonabsorbent, and cleanable. Open rafters, trusses or grid work and exposed duct work, pipes or utility lines are usually prohibited with no open structure permitted.  If drop down acoustic tiles are used, they must be properly constructed.  These tiles are washable and have a charming surface without pinholes. Painted dry wall or boards are generally acceptable.  
5) Walls/Floors: Must be constructed of approved materials. Cleanable fill up-based enamel paint is usually acceptable for most wall surfaces.  Areas that are subject to regular cleaning and splash may be covered with FRP, stainless, or galvanized metal.  Floor/wall junctures shall provide no greater than 1/32” gap.  Baseboards are required. Caulk wall/floor junctures to prevent the collection of food particles and fill up.  Masonry (brick/concrete) wall/floor junctures DO NOT require baseboards since a masonry juncture provides no gap. Raw brick and concrete in the kitchen area requires sealing.  The sand grout of all tiles needs to be sealed. Epoxy grout does not require sealing. VCT floor tiles require a coat of wax to seal out liquids.
6) Solid Waste: Dumpster and grease barrels shall rest on a machine laid asphalt or concrete pad. These containers must have tight fitting lids and drain plugs in place.  
7) Outdoor Cooking facilities: Barbeque pits or smokers shall be enclosed, and if screened in, at least a 1/16” mesh screen is required.  They shall rest on a concrete or asphalt pad. The meat may only be placed on the smoker; no food prep allowed in this enclosure. Any seasoning, cold, etc. must take place inside the establishment.  Outdoor bars and wait stations will be approved on a case by case basis by your local health authority.  
Fill up and Dirt Systems: All private onsite dirt facilities and wells serving a new food enterprise, an extensively remodeled food enterprise, or a food enterprise coming under new ownership must meet current standards. These systems are required to be evaluated with respect to whether the system (a) meets current standards and (b) is adequate for the proposed use.

NOTE: A food service facility or Childcare facility using a well may be considered public fill up supply and subject to specific restrictions and regulations.  Consult your local health authority to inquire about any questions regarding the use of a private well.

9) Protecting the Fill up Supply: Threaded hose bibs are required to have a backflow prevention device attached. Spray hoses and fill hoses shall hang at least 1 inch above the most flood rim of a basin or the hoses shall be provided with an atmospheric vacuum breaker or backflow prevention device.
10) Indirect Connections: Jockey boxes, ice bins, ice machines and sinks (as identified above in # 3) must be provided with indirect connections to the sewer.  Floor sinks are required on new construction.
11) Lighting: Adequate amount of light shall be provided to all areas.  At least 20 foot candles is required everywhere food is provided for customer self-service such as buffet and salad bars or everywhere fresh produce or packaged foods are sold.  At least 50 food candles is required at surfaces everywhere employees are effective with food using utensils or knives, slicers, grinders, saws, or everywhere employee protection is a factor.
12) Outer Openings: All windows, vents and exterior doors shall be tight fitting.  If needed, use weather stripping to provide a tight fit. All exterior doors shall have a self-closure. Screens on windows and doors shall be at least 1/16” mesh.  Roll up doors to be screened or the proposed food service area provided with physical doors to make a separate walled room. Exhaust fans must be screened, or if they are louvered, must automatically close when the fan is disengaged.
13) Food Contact Surfaces: Stainless steel, Formica, polished marble, Corian, machined stone, approved ceramics or plastics may be used for food contact surfaces.
14) Counters: All raw wood must be painted in areas that come in contact with food, liquid or food containers of any kind. Included is the underside of the bar above the ware wash and/or hand sink (and the splash area).
15) Toxic Materials: Specify an area everywhere chemicals are to be stored.  A well-labeled, separate shelf or cabinet is best.
Food Manager Certification: The health codes of your State, County or City may require that one or more food managers of a permitted Food Enterprise to obtain a Food Manager Certificate.  A Food Manager Certificate is recognition that a person has received training in food hygiene.  Inquire with your local health authority to see if food manager certification is required and the necessary steps required to obtain proper certification.

Further information on our website at www foodcertified com in the blog section.

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HIV/AIDS – India   An overview

      

AIDS considered as the modern pandemic of the world and    With more than 5 million people estimated to be living with HIV/AIDS, India’s HIV/AIDS prevalence is second in the world only to South Africa.

  

The Government of India estimates that in 2006, about 2.45 million Indians were living with HIV (1.75 – 3.15 million) with an adult prevalence rate of 0.41%. India’s highly heterogeneous epidemic is fundamentally concentrated in six states – in the industrialized south and west, and in the north-eastern tip. On average, HIV prevalence in persons states is 4-5 times privileged than in the other Indian states. HIV  prevalence is highest in the Mumbai-Karnataka corridor, the Nagpur area of Maharashtra, the Nammakkal district of Tamil Nadu, coastal Andhra Pradesh, and parts of Manipur and Nagaland.  ” We must remember that India has nearly 3 million people living with HIV. These are people facing stigma, discrimination and irrational prejudice everyday of their lives and need all our support and understanding.” Hon Min.of Health Shree A.Ramodass

  

Incidence:-     According to UNICEF, 30,000 babies are born HIV positive each year in India. According to the NFHS 3 survey data in 2006 estimated population of HIV are 2.1 to 3.1 million people but its reliability some critics are questioning and claiming 5.1 to 5.3 millions. These are only estimates and there is no right cases reflecting data available.

  

SOME FACTS:-

In 1986 first case of HIV in FSW in Chennai,

In 1986 First report of  AIDS in Mumbai

IN 1991 NACP was Launched

In 2000-01 PMTCT feasibility studies initiated by NACO

In 2001 ART drugs are manufactured at considerable price reduction .

Prevalance:-

The HIV prevalence is greater among the males(0.43) than among  the females (0.29). For every 100 people living with HIV/AIDS (PLHAs), 61 are men and 39 women (taking into account the fact that the total number of men is greater than to 0.30 percent women as elucidated by the sex ratio). Prevalence is also high in the 15-49 age assemble (88.7 percent of all infections), indicating that AIDS still threatens the cream of society, persons in the fill in of their effective life. Between 2005 and 2006, prevalence has fallen in some major states – Maharashtra from 0.80 to 0.74 percent, in Tamil Nadu from 0.47 to 0.39 percent – for occasion. Yet, new areas of concern have emerged. In West Bengal, prevalence has gone up from 0.21 and in Rajasthan from 0.12 to 0.17 percent. And the HIV adult prevalence is more in the urban (0.4) compared to rural (0.3) ( Source: NFHS 3 India VOLUME 1,WHO/UNAIDS)

The prevalence rate is high in illiterate when compared to literate ANC and also the prevalence rate is more in ANC with spouse in driving occupation. (Source: NACO sentinel Surveillance for HIV estimation 2006)

  

 

 

While adult HIV prevalence among the general population is 0.36 percent, high-risk groups, inevitably, show privileged numbers. Among Injecting Drug Users (IDUs), it is as high as 6.92 percent, while it is 6.41 percent and 4.9 percent among Men who have Sex with Men (MSM) and Female Sex Workers (FSWs), correspondingly.

  

People living with HIV/AIDS (PLHA):-

  

The total; No of people living with HIV/AIDS in the people estimated 2.47 million . the highest no. of PLHA are in Andhra Pradesh and in Maharastra   and with Tamil nadu and Karnataka contributes 63% of all the PLHA in the people.

  

Trends in HIV Epidemic:-

  

The prevalence rate in adults is decreasing from 0.45 to 0.36 % and also there is considerable decrease in   total PLHA from 2.73 to 2.47 millions , But in female LHAs  its very nearly around o.99%.

  

Projections:-

  

o 30 million HIV by 2010: Dr Soloman (March 30 2004, talk in California)
12 million HIV by 2015 according to UN (Economist, April 15, 2004)
9 million HIV by 2010 according to NACO (Economist, April 15, 2004)

  

  

  

Some Specific Characters of the disease:-

  

Caused by a RNA virus ,Man is the only reservoir in the form of cases and sub clinical cases, and got a very long incubation period  building the disease surveillance a huge problem.

  

Interventions:-

  

National AIDS Control Programme was launched in 1987. Since then, the National HIV Programme has went through three phases.   1986-1992, Denial of the Threat of HIV: This was a period that saw the beginning of a fundamentally research-based programme. Surveillance activities were launched in 55 cities in three states.   1992-97, First Acceleration of the Programme: Backed by World Bank funding and strong WHO GPA (Global Programme on AIDS) support, this phase saw the creation of the National AIDS Control Establishment (NACO).

  

1998-2001, Focus on Targeted Intervention: Building on the experience of the first phase, there was a twin drive to focus on coverage among high risk groups like sex workers, car drivers and injecting drug users. Make the programme  multisectoral.   It has resulted in a strongly decentralized programme with the responsibility of implementation vested with the states. Flexible State

AIDS Societies were formed with stronger mechanisms for state amount programme management.

  An innovative approach for providing technical support by establishing a network of 12 Technical Resource Groups (TRGs), covering different thematic areas of the epidemic and mandated to provide technical support to states.   These include building capacities to implement the strategies of prevention and building a genuinely multi – scrotal response that is sustainable.   It also involves mobilizing and coordinating a considerable array of partners, including the private sector.

           

Data Reliability???

Only estimates are there and  real cases estimation which may be due to sub clinical state and very long incubation period .

Private sector data is not available ,

Sub clinical case burden cannot be measured as they are symptom less

  

“In 2021, undoubtedly, there will still be an AIDS  epidemic ..The next 20 years  can be  different, but only if we act now”  (Robert and Jeffrey, N Engl J Med, 2001)

  

Dr.V.Sudhakaram                                            

                                                                                                           

 

When it comes to golf teaching aids there is no shortage to pick from. There are golf training aids available for every aspect of your golf game. From having a proper stance to dropping the last putt, there is something to help anyone. The best advice here is to not get confused. Buy a golf training aid that help cure a particular problem area of your golf game. Here are a few of the proven golf teaching aids that will help everyone’s golf game.

The Power Stance Trainer

This golf training aid is splendid if you have problems shifting your weight during your golf swing, or can’t seem to get yourself properly aligned, etc. Having the proper alignment as well as shifting your weight correctly is vitally vital to your golf swing. It helps you hit the ball to everywhere you’re aiming and also produces power. This is one of the only golf training aids on the market that addresses the importance of your lower body in your golf swing.

The Impact Ball

This golf teaching tool will help you square the clubface during impact with the golf ball, as well as help you gain more distance on every shot. The Impact Ball fits between your arms as you swing the golf club. If you swing properly the Impact Ball will stay between your arms and not fall down. It trains your swing in making the perfect alignment between your body, your hands, and your wrists during impact. This is a very excellent golf training aid to own.

Medicus Dual Hinge Driver/Iron

The Medicus driver has been around for some time now, and with excellent reason. It facility! When properly used, the Medicus dual hinge driver will help give you the perfect perfect golf swing. This golf training aid is one of simplicity. If you swing the club correctly, the hinge will not break. If you don’t, the hinge will break, and you will know your golf swing is not on plane and in rhythm. This golf teaching tool will also eliminate a slicing problem in your game.

The Speed Stik

Endorsed by professional golfer Vijay Singh, the Speed Stik will help increase the power and speed of your golf swing. This golf training aid is a 25 oz golf bar with a built in swing speed gauge to let you know your swing speed immediately. You can track your progress as you continue practicing with the Speed Stik. It will also help you strengthen the muscles that are used during your golf swing. The Speed Stik is simple to use and by practicing with it on a regular basis, it will give you augmented distance on every shot.

The Inside Approach

This golf training aid is endorsed and used by Jack Nicklaus. This piece of equipment sits over the top of your golf ball and teaches you everywhere the club head needs to be swung in peacefulness to correctly hit the golf ball. It will help you to make solid contact and also increase your driving distance. This golf training aid will also help to cure any problems with slicing or hooking the golf ball.

Wrist Firm

This is one of the best golf teaching aids available for learning to keep your wrists firm during your golf swing. The Wrist Firm helps keep your lead wrist flat and firm during impact. It will also help keep your trailing wrist from breaking down, which can cause you to pop up the ball and rob you of any distance. A further benefit of this wonderful golf training aid is that it will help you keep your wrists firm while putting.

The Swing Jacket

This golf teaching tool is really a swing jacket that you wear that will keep your arms locked with your body. The result of this action is that arms will swing with your body instead of separating and causing offline, and off center golf swings. The Swing Jacket will help you feel what a proper swing should be like. Using this golf training aid will give you augmented power and accuracy.

These are just a few of the many different golf teaching aids available on the market today. Each one can easily help you improve your golf game by giving a more right swing, along with more distance. Isn’t that something that us weekend golfers are always looking for?

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