Frequently Asked Questions (FAQs)

AIDS: Some Questions and Answers

Q: What are HIV and AIDS?
A: HIV is the human immunodeficiency virus. It is the virus that can lead to acquired immune deficiency syndrome, or AIDS. HIV damages a person’s body by destroying specific blood cells, called CD4+ T cells, which are crucial to helping the body fight diseases.
AIDS stands for Acquired Immunodeficiency Syndrome.
Acquired – means that the disease is not hereditary but develops after birth from contact with a disease-causing agent (in this case, HIV). Immunodeficiency – means that the disease is characterized by a weakening of the immune system.
Syndrome – refers to a group of symptoms that indicate or characterize a disease. In the case of AIDS, this can include the development of certain infections and/or cancers, as well as a decrease in the number of certain specific blood cells, called CD4+ T cells, which are crucial to helping the body fight disease.
Before the development of certain medications, people with HIV could progress to AIDS in just a few years. Currently, people can live much longer - even decades - with HIV before they develop AIDS. This is because of “highly active” combinations of medications that were introduced in the mid 1990s.
A diagnosis of AIDS is made by a physician using specific clinical or laboratory standards.
AIDS (acquired immunodeficiency syndrome) is the late stage of infection with human immunodeficiency virus (HIV). AIDS can take more than 8-10 years to develop after infection with HIV. HIV-infected people can live symptom-free lives for years; however most people in developing countries die within three years of being diagnosed with AIDS.

Q: How do people get infected with HIV?
A: HIV is transmitted mostly through semen and vaginal fluids during unprotected sex without the use of condoms. Globally, most cases of sexual transmission involve men and women, although in some developed countries homosexual activity remains the primary mode. Besides sexual intercourse, HIV can also be transmitted during drug injection by the sharing of needles contaminated with infected blood; by the transfusion of infected blood or blood products; and from an infected woman to her baby – before birth, during birth or just after delivery.
HIV is not spread through ordinary social contact; for example by shaking hands, travelling in the same bus, eating from the same utensils, by hugging or kissing. Mosquitoes and insects do not spread the virus nor is it water-borne or air-borne.

Q. How long does it take for HIV to cause AIDS?
A: Prior to 1996, scientists estimated that about half the people with HIV would develop AIDS within 10 years after becoming infected. This time varied greatly from person to person and depended on many factors, including a person's health status and their health-related behaviors.
Since 1996, the introduction of powerful antiretroviral therapies has dramatically changed the progression time between HIV infection and the development of AIDS. There are also other medical treatments that can prevent or cure some of the illnesses associated with AIDS, though the treatments do not cure AIDS itself. Because of these advances in drug therapies and other medical treatments, estimates of how many people will develop AIDS and how soon are being recalculated, revised, or are currently under study.
As with other diseases, early detection of infection allows for more options for treatment and preventative health care.

Q. What is the evidence that HIV causes AIDS?
A: The epidemic of HIV and AIDS has attracted much attention both within and outside the medical and scientific communities. Much of this attention comes from the many social issues related to this disease such as sexuality, drug use, and poverty. Although the scientific evidence is overwhelming and compelling that HIV is the cause of AIDS, the disease process is still not completely understood. This incomplete understanding has led some persons to make statements that AIDS is not caused by an infectious agent or is caused by a virus that is not HIV. This is not only misleading, but may have dangerous consequences. Before the discovery of HIV, evidence from epidemiologic studies involving tracing of patients’ sex partners and cases occurring in persons receiving transfusions of blood or blood clotting products had clearly indicated that the underlying cause of the condition was an infectious agent. Infection with HIV has been the sole common factor shared by AIDS cases throughout the world among men who have sex with men, transfusion recipients, persons with hemophilia, sex partners of infected persons, children born to infected women, and occupationally exposed health care workers.
The conclusion after more than 28 years of scientific research is that people, if exposed to HIV through sexual contact or injecting drug use for example, may become infected with HIV. If they become infected, most will eventually develop AIDS.

Q. How can I tell if I'm infected with HIV?
A: The only way to know if you are infected is to be tested for HIV infection. You cannot rely on symptoms to know whether or not you are infected. Many people who are infected with HIV do not have any symptoms at all for 10 years or more. The following may be warning signs of advanced HIV infection:
o rapid weight loss
o dry cough
o recurring fever or profuse night sweats
o profound and unexplained fatigue
o swollen lymph glands in the armpits, groin, or neck
o diarrhea that lasts for more than a week
o white spots or unusual blemishes on the tongue, in the mouth, or in the throat
o pneumonia
o red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids
o memory loss, depression, and other neurological disorders
However, no one should assume they are infected if they have any of these symptoms. Each of these symptoms can be related to other illnesses. Again, the only way to determine whether you are infected is to be tested for HIV infection. For information on where to find an HIV testing site, call CAAP - +88-02-9884266 (Form 10:00 am to 4:30 pm, excluding holidays).
You also cannot rely on symptoms to establish that a person has AIDS. The symptoms of AIDS are similar to the symptoms of many other illnesses. AIDS is a medical diagnosis made by a doctor based on specific criteria established by WHO or CDC.

Q. Should I get tested?
A: The following are behaviors that increase your chances of getting HIV. If you answer yes to any of them, you should definitely get an HIV test. If you continue with any of these behaviors, you should be tested every year. Talk to a health care provider about an HIV testing schedule that is right for you.
o Have you injected drugs or steroids or shared equipment (such as needles, syringes, works) with others?
o Have you had unprotected vaginal, anal, or oral sex with men who have sex with men, multiple partners, or anonymous partners?
o Have you exchanged sex for drugs or money?
o Have you been diagnosed with or treated for hepatitis, tuberculosis (TB), or a sexually transmitted disease (STD), like syphilis?
o Have you had unprotected sex with someone who could answer yes to any of the above questions?
If you have had sex with someone whose history of sex partners and/or drug use is unknown to you or if you or your partner has had many sex partners, then you have more of a chance of being infected with HIV. Both you and your new partner should get tested for HIV, and learn the results, before having sex for the first time.
For women who plan to become pregnant, testing is even more important. If a woman is infected with HIV, medical care and certain drugs given during pregnancy can lower the chance of passing HIV to her baby. All women who are pregnant should be tested during each pregnancy.

Q. How do HIV tests work?
A: Once HIV enters the body, the immune system starts to produce antibodies – (chemicals that are part of the immune system that recognize invaders like bacteria and viruses and mobilize the body's attempt to fight infection). In the case of HIV, these antibodies cannot fight off the infection, but their presence is used to tell whether a person has HIV in his or her body. In other words, most HIV tests look for the HIV antibodies rather than looking for HIV itself. There are tests that look for HIV's genetic material directly, but these are not in widespread use.
The most common HIV tests use blood to detect HIV infection. Tests using saliva or urine are also available. Some tests take a few days for results, but rapid HIV tests can give results in about 20 minutes. All positive HIV tests must be followed up by another test to confirm the positive result. Results of this confirmatory test can take a few days to a few weeks.

Q. How long after a possible exposure should I wait to get tested for HIV?
A: Most HIV tests are antibody tests that measure the antibodies your body makes against HIV. It can take some time for the immune system to produce enough antibodies for the antibody test to detect, and this time period can vary from person to person. This time period is commonly referred to as the “window period”. Most people will develop detectable antibodies within 2 to 8 weeks (the average is 25 days). Even so, there is a chance that some individuals will take longer to develop detectable antibodies. Therefore, if the initial negative HIV test was conducted within the first 3 months after possible exposure, repeat testing should be considered >3 months after the exposure occurred to account for the possibility of a false-negative result. Ninety-seven percent of persons will develop antibodies in the first 3 months following the time of their infection. In very rare cases, it can take up to 6 months to develop antibodies to HIV.
Another type of test is an RNA test, which detects the HIV virus directly. The time between HIV infection and RNA detection is 9–11 days. These tests, which are more costly and used less often than antibody tests, are not used in Bangladesh.
For information on HIV testing, you can call to CAAP: +88-02-9884266 (Form 10:00 am to 4:30 pm, excluding holidays).

Q. If I test HIV negative, does that mean that my partner is HIV negative also?
A: No. Your HIV test result reveals only your HIV status. Your negative test result does not indicate whether or not your partner has HIV. HIV is not necessarily transmitted every time you have sex. Therefore, your taking an HIV test should not be seen as a method to find out if your partner is infected. Ask your partner if he or she has been tested for HIV and what risk behaviors he or she has engaged in, both currently and in the past. Think about getting tested together.
It is important to take steps to reduce your risk of getting HIV. Not having (abstaining from) sex is the most effective way to avoid HIV. If you choose to be sexually active, having sex with one person who only has sex with you and who is uninfected is also effective. If you are not sure that both you and your partner are HIV negative, use a latex condom to help protect both you and your partner from HIV and other STDs. Studies have shown that latex condoms are very effective, though not 100%, in preventing HIV transmission when used correctly and consistently. If either partner is allergic to latex, plastic (polyurethane) condoms for either the male or female can be used.

Q. What if I test positive for HIV?
A: If you test positive for HIV, the sooner you take steps to protect your health, the better. Early medical treatment and a healthy lifestyle can help you stay well. Prompt medical care may delay the onset of AIDS and prevent some life-threatening conditions. There are a number of important steps you can take immediately to protect your health:

o Contact CAAP, even if you do not feel sick. Or try to find a health care provider who has experience treating HIV. There are now many medications to treat HIV infection and help you maintain your health. It is never too early to start thinking about treatment possibilities.
o Have a TB (tuberculosis) test. You may be infected with TB and not know it. Undetected TB can cause serious illness, but it can be successfully treated if caught early.
o Smoking cigarettes, drinking too much alcohol, or using illegal drugs (such as methamphetamines) can weaken your immune system.
o Get screened for other sexually transmitted diseases (STDs). Undetected STDs can cause serious health problems. It is also important to practice safe-sex behaviors so you can avoid getting STDs.

There is much you can do to stay healthy. Learn all that you can about maintaining good health.
Not having (abstaining from) sex is the most effective way to avoid transmitting HIV to others. If you choose to have sex, use a latex condom to help protect your partner from HIV and other STDs. Studies have shown that latex condoms are very effective, though not 100%, in preventing HIV transmission when used correctly and consistently. If either partner is allergic to latex, plastic (polyurethane) condoms for either the male or female can be used.

Q: How many people are affected with HIV?
A: According to WHO estimates, by end-2009, nearly 33.4 million people – including over 2.1 million children – is living with HIV since the start of the pandemic. Over 7400 new HIV infections a day in 2008
• More than 97% are in low- and middle-income countries
• About 1200 are in children under 15 years of age
• About 6200 are in adults aged 15 years and older, of whom: — almost 48% are among women — about 40% are among young people (15–24) More than 280 000 people died of AIDS in 2008.

Q: Does AIDS also affect our region?
A: Of the 26.8 million adults with HIV infection – the global estimate in end-1996 – 14 million were in Sub-Saharan Africa and more than 3.5 million in Asia. Our region, that is South-East Asia, is likely to suffer the brunt of the pandemic - being home to over half the world’s population. Moreover, HIV/AIDS is now present in every continent and in every region of the world.

Q: Why is the AIDS epidemic considered so serious?
A: AIDS affects people primarily when they are most productive and leads to premature death thereby severely affecting the socioeconomic structure of whole families, communities and countries. Besides, AIDS is not curable and since HIV is transmitted predominantly through sexual contact, and with sexual practices being essentially a private domain, these issues are difficult to address.

Q: How can I avoid being infected through sex?
A: You can avoid HIV infection by abstaining from sex, by having a mutually faithful monogamous sexual relationship with an uninfected partner or by practicing safer sex. Safer sex involves the correct use of a condom during each sexual encounter and also includes non-penetrative sex.

Q: Can we assume responsibility in preventing HIV infection?
A: Both men and women share the responsibility for avoiding behaviour that might lead to HIV infection. Equally, they also share the right to refuse sex and assume responsibility for ensuring safe sex. In many societies, however, men have much more control than women over when, with whom and how they have sex. In such cases, men need to assume greater responsibility for their actions.

Q: Does the presence of other sexually transmitted diseases (STDs) facilitate HIV transmission?
A: Yes. Every STD causes some damage to the genital skin and mucous layer, which facilitates the entry of HIV into the body. The most dangerous are:
 Syphilis
 Chancroid
 Genital herpes
 Gonorrhoea

Q: Why is early treatment of STD important?
A: High rates of STD caused by unprotected sexual activity enhance the transmission risk in the general population. Early treatment of STD reduces the risk of spread to other sexual partners and also reduces the risk of contracting HIV from infected partners. Besides, early treatment of STD also prevents infertility and ectopic pregnancies.

Q: How can children and young people be protected from HIV?
A: Children and adolescents have the right to know how to avoid HIV infection before they become sexually active. As some young people will have sex at an early age, they should know about condoms and where they are available. Parents and schools share the responsibility of ensuring that children understand how to avoid HIV infection, and learn the importance of tolerant, compassionate and non-discriminatory attitudes towards people living with HIV/AIDS.

Q: How does a mother transmit HIV to her unborn child?
A: An HIV-infected mother can infect the child in her womb through her blood. The baby is more at risk if the mother has been recently infected or is in a later stage of AIDS. Transmission can also occur at the time of birth when the baby is exposed to the mother’s blood and to some extent transmission can occur through breast milk. Transmission from an infected mother to her baby occurs in about 30% of cases.

Q: Can HIV be transmitted through breast-feeding?
A: Yes. The virus has been found in breast milk in low concentrations and studies have shown that children of HIV-infected mothers can get HIV infection through breast milk. Breast milk, however, has many substances in it that protect an infant’s health and the benefits of breast-feeding for both mother and child are well recognized. The slight risk of an infant becoming infected with HIV through breast-feeding is therefore thought to be outweighed by the benefits of breast-feeding

Q: Can blood transfusions transmit HIV infection?
A: Yes. If the blood contains HIV. In many places blood is now screened for HIV before it is transfused. If you need a transfusion, try to ensure that screened blood is used. You can reduce the chances of needing a blood transfusion by taking ordinary precautions against serious injury – for example, by driving carefully, insisting on wearing a seat belt, and avoiding alcohol.

Q: Can injections transmit HIV infection?
A: Yes. If the injecting equipment is contaminated with blood containing HIV. Avoid injections unless absolutely necessary. If you must have an injection, make sure the needle and syringe come straight from a sterile package or have been sterilized properly; a needle and syringe that has been cleaned and then boiled for 20 minutes is ready for reuse. Finally, if you inject drugs, of whatever kind, never use anyone else’s injecting equipment.

Q: What about having a tattoo or your ears pierced?
A: Tattooing, ear piercing, acupuncture and some kinds of dental work all involve instruments that must be sterile to avoid infection. In general, you should refrain from any procedure where the skin is pierced, unless absolutely necessary.

Q: How serious is the interaction between HIV and TB in South-East Asia?
A: Tuberculosis kills nearly 3 million people globally, of whom nearly 50% are Asians. The rapid spread of HIV in the region has further complicated the already serious situation. Not only is TB the commonest life-threatening opportunistic infection among patients living with AIDS, but the incidence of TB has now begun to increase, particularly in areas where HIV seroprevalence is high. Multi-drug resistant TB is also quite common in many areas.

Q: What efforts are being made to integrate HIV/AIDS/STD prevention and control activities into primary health care?
A: Integration into primary health care is a priority because it is necessary for ensuring sustainability. Two examples of an integrated approach are the implementation of HIV/AIDS care and STD prevention and control. For example, a continuum of HIV/AIDS care is being promoted as part of primary health care, with linkages to be established between institutional, community and home levels. In the area of STD prevention and control, a syndromic approach to STD diagnosis is most suitable in the developing world as it does not require laboratory tests, and treatment can be given at the first contact with health services. WHO strongly advocates that all primary health care workers be trained in the syndromic approach to STD management.

Q: Is there a vaccine for HIV/AIDS? What is WHO's role in this regard?
A: While there is currently no vaccine for HIV/AIDS, research is under way. Sixteen candidate vaccines are presently undergoing either phase I or phase II clinical trials in various countries, including Thailand in South-East Asia. These will be followed by field trials in the community to determine efficacy, which is a time consuming process and will take another 3-5 years or more. Hence, a vaccine for general use is unlikely to be available in the near future. WHO’s role is to assist in the development, evaluation and availability of vaccines. WHO has helped four countries – Brazil, Rwanda, Thailand and Uganda – to prepare a comprehensive plan for HIV vaccine research including strengthening of national epidemiological, laboratory and socio-behavioural research capabilities

Q: Is there a treatment for HIV/AIDS?
A: All the currently licensed anti-retroviral drugs, namely AZT, dd1 and ddC, have effects which last only for a limited duration. In addition, these drugs are very expensive and have severe adverse reactions while the virus tends to develop resistance rather quickly with single-drug therapy. The emphasis is now on giving a combination of drugs including newer drugs called protease inhibitors; but this makes treatment even more expensive. WHO’s present policy does not recommend antiviral drugs but instead advocates strengthening of clinical management for HIV-associated opportunistic infections such as tuberculosis and diarrhoea. Better care programmes have been shown to prolong survival and improve the quality of life of people living with HIV/AIDS

Q: How should governments share responsibility?
A: Governments are responsible for ensuring that enough resources are allocated to AIDS prevention and care programmes, that all individuals and groups in society have access to these programmes, and that laws, policies and practices do not discriminate against people living with HIV/AIDS. Governments of developed countries have a moral responsibility to share the AIDS burden of developing countries.

Q: Do people living with HIV/AIDS have special rights or responsibilities?
A: Since everyone is entitled to fundamental human rights without discrimination, people living with HIV/AIDS have the same rights as seronegative people to education, employment, health, travel, marriage, procreation, privacy, social security, scientific benefits, asylum, etc. Seronegative and seropositive people share responsibility for avoiding HIV infection/re-infection. But many people, including women, children and teenagers, cannot negotiate safe sex because of their low status in society or lack of personal power. Therefore men, whether knowingly infected or unaware of their HIV status, have a special responsibility of not putting others at risk.

AIDS BackgroA: AIDS is caused by a virus called HIV, but where this virus came from is not known. However, as new facts are discovered about viruses like HIV, the question of where HIV first came from is becoming more complicated to answer. Moreover, such questions are no longer relevant and do not help in our efforts to combat this epidemic. What is more important is the fact that HIV is present in all countries and we need to determine how best to prevent the further spread of this deadly virus.
The earliest known case of infection with HIV-1 in a human was detected in a blood sample collected in 1959 from a man in Kinshasa, Democratic Republic of the Congo. (How he became infected is not known.) Genetic analysis of this blood sample suggested that HIV-1 may have stemmed from a single virus in the late 1940s or early 1950s.
We know that the virus has existed in the United States since at least the mid- to late 1970s. From 1979–1981 rare types of pneumonia, cancer, and other illnesses were being reported by doctors in Los Angeles and New York among a number of male patients who had sex with other men. These were conditions not usually found in people with healthy immune systems.
In 1982 public health officials began to use the term "acquired immunodeficiency syndrome," or AIDS, to describe the occurrences of opportunistic infections, Kaposi's sarcoma (a kind of cancer), and Pneumocystis jirovecii pneumonia in previously healthy people. Formal tracking (surveillance) of AIDS cases began that year in the United States. In 1983, scientists discovered the virus that causes AIDS. The virus was at first named HTLV-III/LAV (human T-cell lymphotropic virus-type III/lymphadenopathy-associated virus) by an international scientific committee. This name was later changed to HIV (human immunodeficiency virus). > For many years scientists theorized as to the origins of HIV and how it appeared in the human population, most believing that HIV originated in other primates. Then in 1999, an international team of researchers reported that they had discovered the origins of HIV-1, the predominant strain of HIV in the developed world. A subspecies of chimpanzees native to west equatorial Africa had been identified as the original source of the virus. The researchers believe that HIV-1 was introduced into the human population when hunters became exposed to infected blood.

Q: Where was AIDS found?
A: AIDS was first recognized in the United States in 1981. However, it is clear that AIDS cases had occurred in several parts of the world before 1981. Evidence now suggests that the AIDS epidemic began at roughly the same time in several parts of the world, including the U.S.A. and Africa

A: If we look at AIDS as a worldwide pandemic, it appears as if it is something new and rather sudden. But if we look at AIDS as a disease and at the virus that causes it, we get a different picture. We find that both the disease and the virus are not new. They were there well before the epidemic occurred. We know that viruses sometimes change. A virus that was once harmless to humans can change and become harmful. This is probably what happened with HIV long before the AIDS epidemic.
What is new is the rapid spread of the virus. It may be compared with a weed that someone brings home from a distant place. In its original environment the weed survives but does not spread much. However, once it takes root in the new environment, conditions may allow it to grow much better than it did before. It spreads, chokes out other plants, and becomes a nuisance. The spread of HIV is somewhat similar.
Researchers believe that the virus was present in isolated population groups years before the epidemic began. Then the situation changed; people moved more often and travelled more; they settled in big cities; and lifestyles changed, including patterns of sexual behaviour. It became easier for HIV to spread through sexual intercourse and contaminated blood. As the virus spread, the disease which was already in existence became a new epidemic.

AIDS and Women

Q: Are women at equal risk of getting infected with HIV?
A: Women are in fact more at risk of getting infected because of their increased vulnerability. In addition, their low status within the family and society further heighten their vulnerability to infection. It is therefore most important that every woman has access to information about HIV/AIDS to protect herself.

AIDS and Children

Q: Does AIDS affect children?
A: Yes. Children can be both infected and affected by AIDS. Over 2.1 million children worldwide are now infected with HIV. If HIV continues to spread in countries, there will be a great increase in deaths among infants and children. It is also estimated that by the year 2008, more than 10 million children will have been orphaned as their parents die of AIDS.

AIDS and Care

Q: Who should provide care to HIV/AIDS affected persons?
A: Everyone in contact with an HIV/AIDS person is a potential care provider. In particular, this includes health care workers at various levels of the health care delivery system, social workers and counsellors, and close family members who are important care providers at home. Care basically involves clinical management, nursing care, counselling and social support.

AIDS and NGOs

Q: What role do NGOs play in AIDS control?
A: NGOs have an important and very special role to play. The close interpersonal interaction that NGOs have with people in the communities they work in is extremely useful for implementing the behavioural interventions necessary for HIV/AIDS prevention and care. NGOs are also not under the same political constraints as government programmes are. They therefore have greater flexibility and the capacity to accommodate changing programmes and public needs and can innovate and implement new initiatives more easily.

AIDS and the Workplace

Q: Is it safe to work with someone infected with HIV?
A: Yes. Most workers face no risk of getting the virus while doing their work. If they have the virus themselves, they are not a risk to others during the course of their work.

Q: Why are people safe from HIV infection during work?
A: As explained already, in adults, the virus is mainly transmitted through the transfer of blood or sexual fluids. Since contact with blood or sexual fluids is not part of most people’s work, most workers are safe.

Q: What about working every day in close physical contact with an infected person?
A: There are no risks involved. You may share the same telephone with other people in your office or work side by side in a crowded factory with other HIV infected persons, even share the same cup of tea, but this will not expose you to the risk of contracting the infection. Being in contact with dirt and sweat will also not give you the infection.

Q: If a worker has HIV infection, should he or she be allowed to continue work?
A: Workers with HIV infection who are still healthy should be treated in the same way as any other worker. Those with AIDS or AIDS-related illnesses should be treated in the same way as any other worker who is ill. Infection with HIV is not a reason in itself for termination of employment

Q: Why should young people be concerned about HIV/AIDS?
A: The reasons for the important role of young people depend upon several factors:
 A major proportion of HIV infection occurs in young people.
 Young people are at a high risk of acquiring sexually transmitted infections, including HIV if they experiment with sex as a part of their growing up.
 Young people can communicate better with other young people than older people can. This means their role as peer educators and motivators can not be taken by other people.
 Young people have the enthusiasm, energy and idealism that can be harnessed for spreading the message of HIV/AIDS awareness and responsible sexual behaviour.
 Young persons can spread the message not only to their peers and to younger children, but also to their families and the community.
 Young persons can ideally serve as role models for younger children and their peers.

Q: What can young people do about HIV and AIDS?
A: Young people have a vital role in the prevention and control of HIV infection. Their role extends from protecting themselves, protecting their peers to protecting their families and their community. ity.
 First of all young people should make it a point to learn as much as possible about HIV/AIDS. They must know how the disease spreads and, more importantly how it does not spread.
 They must push their teachers and other role models to tell them more about HIV/AIDS and to discuss the prevention openly and exhaustively.
 They must discuss aspects of HIV/AIDS and sexuality openly with their peers.
 They must spread the message of responsible sexual behaviour amongst their friends, community and, if possible, their family.
 They must set an example of responsible sexual behaviour for their peers and for younger persons.
 They must encourage the prompt and correct treatment of STIs, from an appropriate care provider such as a doctor.
 They should encourage and help in voluntary donation of blood to a certified blood bank.