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Introduction The Multi-Fiber Arrangement (MFA) has governed international trade in textiles and clothing since 1974. The MFA enabled developed nations, mainly the USA, European Union and Canada to restrict imports from developing countries through a system of quotas. The Agreement on Textiles and Clothing (ATC) to abolish MFA quotas marked a significant turnaround in the global textile trade. The ATC mandated progressive phase out of import quotas established under MFA, and the integration of textiles and clothing into the multilateral trading system before January 2005. The Agreement on Textiles and Clothing ATC is a transitory regime between the MFA and the integration of trading in textiles and clothing in the multilateral trading system. The ATC provided for a stage-wise integration process to be completed within a period of ten years (1995-2004), divided into four stages starting with the implementation of the agreement in 1995. The product groups from which products were to be integrated at each stage of the integration included (i) tops and yarns; (ii) fabrics; (iii) made-up textile products; and (iv) clothing. The ATC mandated that importing countries must integrate a specified minimum portion of their textile and garment exports based on total volume of trade in 1990, at the start of each phase of integration. In the first stage, each country was required to integrate 16 percent of the total volume of imports of 1990, followed by a further 17 percent at the end of first three year and another 18 percent at the end of third stage. The fourth stage would see the final integration of the remaining 49 percent of trade. Global Trade in Textile and Clothing World trade in textiles and clothing amounted to US $ 385 billion in 2003, of which textiles accounted for 43 percent (US $ 169 bn) and the remaining 57 percent (US $ 226 bn) for clothing. Developed countries accounted for little over one-third of world exports in textiles and clothing. The shares of developed countries in textiles and clothing trade were estimated to be 47 percent (US $ 79 bn) and 29 percent, (US $ 61 bn) respectively. Import Trends in USA In 1990, restrained or MFA countries contributed as much as 87 percent (US $ 29.3 bn) of total US textile and clothing imports, whereas Caribbean Basin Initiative (CBI), North American Free Trade Area (NAFTA), Africa Growth and Opportunity Act (AGOA) and ANDEAN countries together contributed 13 percent (US $ 4.4 bn). Thereafter, there has been a decline in exports by restrained countries; the share of preferential regions more than doubled to reach 30 percent (US $ 26.9 bn) of total imports by USA. The composition of imports of clothing and textiles by USA in 2003 was 80 percent (US $ 71 bn) and 20 percent (US $ 18 bn), respectively. Asia was the principal sourcing region for imports of both textiles and clothing by USA. Latin American region stood at second position with a share of 12 percent (US $ 2.2 bn) and 26 percent (US $ 18.5 bn), respectively, for textiles and clothing imports, by USA. In most of the quota products imported by USA, India was one of the leading suppliers of readymade garments in USA. Though China is a biggest competitor, the unit prices of China for most of these product groups were high and thus provide opportunities for Indian business. Import Trends in EU EU overtook USA as the world's largest market for textiles and clothing. Intra-EU trade accounted for about 40 percent (US $ 40 bn) of total clothing imports and 62 percent (US $ 32.5 bn) of total textile imports by EU. Asia dominates EU market in both clothing and textiles, with 30 percent (US $ 30 bn) and 17 percent (US $ 8 bn) share, respectively. Central and East European countries hold a market share of 11 percent (US $ 11.3 bn) in clothing and 7.5 percent (US $ 4 bn) in textiles imports of EU. As regards preferential suppliers, the growth of trade between EU and Mediterranean countries, especially Egypt and Turkey, was highest in 2003. As regards individual countries, China accounted for little over 5 percent (US $ 2.8 bn) of EU's imports of textiles and over 12 percent (US $ 12.4 bn) of clothing imports. In the EU market also, India is a leading supplier for many of the textile products. It is estimated that Turkey would emerge as a biggest competitor for both India and China. However, with regard to unit prices, India appears to be lower than both Turkey and China in many of the categories. Import Trends in Canada Amongst the leading suppliers of textiles and clothing to Canada, USA had the highest share of over 31 percent (US $ 8.4 bn), followed by China (21% - US $ 1.8 bn) and EU (8% - US $ 0.6 bn). India was ranked at fourth position and was ahead of other exporters like Mexico, Bangladesh and Turkey, with a market share of 5.2 percent (US $ 0.45 bn). Potential Gains It may be noted that clothing sector would offer higher gains than the textile sector, in the post MFA regime. Countries like Mexico, CBI countries, many of the African countries emerged as exporters of readymade garments without having much of textile base, utilizing the preferential tariff arrangement under the quota regime. Besides, countries like Bangladesh, Sri Lanka, and Cambodia emerged as garment exporters due to cost factors, in addition to the quota benefits. It may be said that countries like China, USA, India, Pakistan, Uzbekistan and Turkey have resource based advantages in cotton; China, India, Vietnam and Brazil have resource based advantages in silk; Australia, China, New Zealand and India have resource based advantages in wool; China, India, Indonesia, Taiwan, Turkey, USA, Korea and few CIS countries have resource based advantages in manmade fibers. In addition, China, India, Pakistan, USA, Indonesia has capacity based advantages in the textile spinning and weaving. China is cost competitive with regard to manufacture of textured yarn, knitted yarn fabric and woven textured fabric. Brazil is cost competitive with regard to manufacture of woven ring yarn. India is cost competitive with regard to manufacture of ring-yarn, O-E yarn, woven O-E yarn fabric, knitted ring yarn fabric and knitted O-E yarn fabric. According to Werner Management Consultants, USA, the hourly wage costs in textile industry is very high for many of the developed countries. Even in developing economies like Argentina, Brazil, Mexico, Turkey and Mauritius, the hourly wage is higher as compared to India, China, Pakistan and Indonesia. From the above analysis, it may be concluded that China, India, Pakistan, Taiwan, Hong Kong, Brazil, Indonesia, Turkey and Egypt would emerge as winners in the post quota regime. The market losers in the short term (1-2 years) would include CBI countries, many of the sub-Saharan African countries, Asian countries like Bangladesh and Sri Lanka. The market losers in the long term (by 2014) would include high cost producers, like EU, USA, Canada, Mexico, Japan and many east Asian countries. The determinants of increase / decrease in market share in the medium term would however depend upon the cost, quality and timely Review of Indian Textiles and Clothing Industry The textiles and garments industry is one of the largest and most prominent sectors of Indian economy, in terms of output, foreign exchange earnings and employment generation. Indian textile industry is multi-fiber based, using delivery. In the long run, there are possibilities of contraction in intra-EU trade in textile and garments, reduction of market share of Turkey in EU and market share of Mexico and Canada in USA, and thus provide more opportunities for developing countries like India. It is estimated that in the short term, both China and India would gain additional market share proportionate to their current market share. In the medium term, however, India and China would have a cumulative market share of 50 percent, in both textiles and garment imports by USA. It is estimated that India would have a market share of 13.5 percent in textiles and 8 percent in garments in the USA market. With regard to EU, it is estimated that the benefits are mainly in the garments sector, with China taking a major share of 30 percent and India gaining a market share of 8 percent. The potential gain in the textile sector is limited in the EU market considering the proposed further enlargement of EU. It is estimated that India would have a market share of 8 percent in EU textiles market as against the China's market share of 12 percent. Review of Indian textiles and Clothing Industry The textiles and garments industry is one of the largest and most prominent sectors of Indian economy, in terms of output, foreign exchange earnings and employment generation. Indian textile industry is multi-fiber based, using cotton, jute, wool, silk and mane made and synthetic fibers. In the spinning segment, India has an installed capacity of around 40 million spindles (23% of world), 0.5 million rotors (6% of world). In the weaving segment, India is equipped with 1.80 million shuttle looms (45% of world), 0.02 million shuttle less looms (3% of world) and 3.90 million handlooms (85% of world). The organised mill (spinning) sector recorded a significant growth during the last decade, with the number of spinning mills increasing from 873 to 1564 by end March 2004. The organised sector accounts for production of almost all of spun yarn, but only around 4 percent of total fabric production. In other words, there are little over 200 composite mills in India leaving the production of fabric and processing to the decentralised small weaving and processing firms. The Indian apparel sector is estimated to have over 25000 domestic manufacturers, 48000 fabricators and around 4000 manufacturer-exporters. Cotton apparel accounts for the majority of Indian apparel exports. Textiles and Garments Exports from India The share of textiles and garments exports in India's total exports in the year 2003-04 stood at about 20 percent, amounting to US $ 12.5 billion. The quota countries, USA, EU and Canada accounted for nearly 70 percent of India's garments exports and 44 percent of India's textile exports. Amongst non-quota countries, UAE is the largest market for Indian textiles and garments; UAE accounted for 7 percent of India's total textile exports and 10 percent of India's garments exports. In terms of products, cotton yarn, fabrics and made-ups are the leading export items in the textile category. In the clothing category, the major item of exports was cotton readymade garments and accessories. However, in terms of share in total imports by EU and USA from India, these products hold relatively lesser share than products made of other fibers, thus showing the restrain in this category. Critical Factors that Need Attention Though India is one of the major producers of cotton yarn and fabric, the productivity of cotton as measured by yield has been found to be lower than many countries. The level of productivity in China, Turkey and Brazil is over 1 tonne / ha., while in India it is only about 0.3 tonne / ha. In the manmade fiber sector, India is ranked at fifth position in terms of capacity. However, the capacity and technology infusion in this sector need to be further enhanced in view of the changing fiber consumption in the world. It may be mentioned that the share of cotton in world fiber demand declined from around 50 percent (14.7 mn tons) in 1982 to around 38 percent (20.12 mn tons) in 2003, while the share of manmade fiber has increased from 44 percent (13.10 mn tons) to around 60 percent (31.76 mn tons) over the same period. Apart from low cost labour, other factors that are having impact on final consumer cost are relative interest cost, power tariff, structural anomalies and productivity level (affected by technological obsolescence). A study by International Textile Manufacturers Federation revealed high power costs in India as compared to other countries like Brazil, China, Italy, Korea, Turkey and USA. Percentage share of power in total cost of production in spinning, weaving and knitting of ring and O-E yarn for India ranged from 10 percent to 17 percent, which is also higher than that of countries like Brazil, Korea and China. Percentage share of capital cost in total production cost in India was also higher ranging from 20 percent to 29 percent as compared to a range of 12 to 26 percent in China. In India, very few exporters have gone in for integrated production facility. It is noted that countries that would emerge as globally competitive would have significantly consolidated supply chain. For instance, competitor countries like Korea, China, Turkey, Pakistan and Mexico have a consolidated supply chain. In contrast, apart from spinning, the rest of the activities like weaving, processing, made-ups and garmenting are all found to be fragmented in India. Besides, the level of technology in the Indian weaving sector is low compared to other countries of the world. The share of shuttle less looms to total loomage in India is 1.8% as compared to Indonesia (10%), Bangladesh (10%), Sri Lanka (12%), China (14%) and Mexico (29%). The supply chain in this industry is not only highly fragmented but is beset with bottlenecks that could very well slow down the growth of this sector. As a result the average delivery lead times (from procurement to fabrication and shipment of garments) still takes about 45-60 days. With international lead delivery times coming down to 30-35 days, India needs to cut down the production cycle time substantially to stay in the market. Besides, erratic supply of power and water, availability of adequate road connectivity, inadequacies in port facilities and other export infrastructure have been adversely affecting the competitiveness of Indian textiles sector. Conclusions It is believed the quota regime has frozen the market share, providing export opportunities even for high cost producers. Thus, in the free trade regime, the pattern of imports in the quota countries would undergo changes. The issues that would govern the market share in the post quota regime would eventually be productivity, raw material base, quality, cost of inputs, including labour, design skills and operation of economies of scale. It is believed that quotas, by limiting the supply of goods have kept export prices artificially high. Thus, it is estimated that there would be price war in the post quota regime, with competitive price cuts. The price and quantity effects would depend on the efficiency in production process, supply chain management and the price elasticity of demand. Due to the expected fall in prices, developing countries with high production cost have little choice but to compete head-on with the biggest low cost suppliers. In this process, it is presumed that there would be better resource reallocation in these economies. It is assumed that quota restrictions would continue beyond 2005 in various forms. It is also widely recognized that removal of quota may not directly provide easy and unrestricted access to developed country markets. There would be non-tariff barriers as well. Standards related to health, safety, environment, quality of work life and child labour would gain further momentum in international trade in textiles and clothing. Strategies and Recommendations Cost competitiveness in Indian garments sector has been restrained by limited scale operations, obsolete technology and reservation under SSI policies. While retaining its traditional cost advantages of home grown cotton and low cost labour, India needs to sharpen its competitive edge by lowering the cost of operations through efficient use of production inputs and scale operations. Besides, there are needs for rationalization of charges, levies related to usage of export logistics to remain cost competitive. As fallout to the quota regime, there would be consolidation of production and restriction on supplying countries, which would necessarily mean improved scale operations. Indian players should also integrate to achieve operating leverage and demonstrate high bargaining power. It is reported that Chinese textile firms have already invested heavily to expand and grab huge market share in the quota free world. In India, organised players in this sector would require huge investments to remain competitive in the quota free world. These players need to expand and integrate vertically to achieve scale operations and introduce new technologies. It is estimated that the industry would require Rs. 1.5 trillion (US $ 35 billion) new capital investment in the next ten years (by 2014) to lap the potential export opportunities of US $ 70 billion. It is estimated that USA and EU together would offer a market of US $ 42 billion for Indian textiles and garments in 2014. Technology would play a lead role in the weaving and processing, which would improve quality and productivity levels. Innovations would also be happening in this sector, as many developed countries would innovate new generation machineries that are likely to have low manual interface and power cost. Indian textile industry should also turn into high technology mode to reap the benefits of scale operations and quality. Foreign investments coupled with foreign technology transfer would help the industry to turn into high-tech mode. Internationally, trading in textile and garment sector is concentrated in the hands of large retail firms. Majority of them are looking for few vendors with bulk orders and hence opting for vertically integrated companies. Thus, there is need for integrating the operations in India also, from spinning to garment making, to gain their attention. This would also bring down the turn around time and improve quality. Indian players should also improve upon their soft skills, viz., design capabilities, textile technology, management and negotiating skills. Garment manufacturing business is order driven. It would be difficult for the players to keep the workforce full time, even in lean season. This calls for changes in contract labour laws. Logistics and supply chain would also play a crucial role as timely delivery would be an important requirement for success in international trade. The logistics and supply chain management of Indian textile firms are relatively weak and needs improvement and efficiency. China has already created a world class export infrastructure. Given the volume of projections for exports by India, it may be necessary to create additional export infrastructure, especially investment for modernization of ports. In addition, India needs to invest for creating brand equity, supply chain management and apparel industry education. To sum up, the ability of Indian textile industry to take advantage of quota phase-out would depend upon their ability to enhance overall competitiveness through exploitation of economies of scale in manufacturing and supply chain. The need of the hour therefore is to evolve a well chalked out strategy, aimed at improvement in the levels of productivity and efficiency, quality control, faster product innovation, quick response to changes in consumer preferences and the ability to move up in the value chain by building brand names and acquiring channels of distribution so as to outweigh the advantages of competitors in the long run. Source: Export-Import Bank of India, India. cheapest penis enlargement pills penis enhancement surgery photo real penis enlagement vimax pillss inch compare penis enlarement pills magna rx plus penis girth elargement penile enlargement surgery photo enlargement penis pills vimax

No matter how physically healthy or unhealthy you are, if you're a man over the age of forty-five, there is a 50 percent chance you have prostate enlargement. Doctors call it benign prostatic hyperplasia (BPH). That's right... a 50% chance! The symptoms of an enlarged prostate are often painful, embarrassing, and frustrating. The most common symptoms are: * A frequent and often urgent need to urinate * A frustrating inability to completely empty the bladder * A weak urine stream, and painful or bloody urination. But the most frustrating symptom is the frequent nighttime urge to urinate that results in sleep-disrupting visits to the bathroom. If you have experienced any of these symptoms, you're not alone. Each year, as many as 12 million American men suffer from symptoms of prostate enlargement http://www.prostatehealthtips.com/prostate-enlargement.html that are so agonizing they are forced to seek medical treatment! In fact, in America today, four out of five American men are likely to develop prostate problems during their lifetime. And those problems aren't limited to BPH. Prostatitis (inflammation of the prostate) can occur in males of any age after puberty. And, unfortunately, prostate cancer is the most common form of cancer among American males, developed by 19 out of every 100 men. Yes, the statistics are frightening. According to Michael B. Schachter, M.D. in The Natural Way to a Healthy Prostate, it is estimated that "the prostate gland accounts for more than 5.5 million doctor visits, 950,000 hospitalizations and 43,500 prostate-related deaths a year." Until recently, your first line of defense against BPH was conventional drugs or surgery, most of which came with a laundry list of horrifying side-effects that include permanent impotence, incontinence, and even death! The good news is... there are now natural treatments available to treat prostate conditions that are safe, effective alternatives to these conventional prescription drugs or surgery. But if you suspect you are suffering from prostate problems, the very first thing to do is have your doctor or urologist accurately diagnose your condition. There are several examinations to detect prostate enlargement and/or other prostate conditions. Some of these methods are referred to by their initials. Digital Rectal Exam Digital rectal exam (or DRE) is usually the first test done. And it's just what it says: your doctor inserts a gloved finger into the rectum and feels the part of the prostate next to the rectum. A DRE exam can give a general idea of the size and condition of the gland, but it's not highly reliable in detecting prostate enlargement, since the part of the prostate that presses on the urethra can't be felt by DRE. It is, however, more useful in diagnosing prostatitis or detecting prostate cancer. PSA Test These are initials you'll hear tossed around a lot in relation to prostates. They stand for Prostate Specific Antigen, a protein produced by both benign and malignant prostate cells. The PSA test measures the amount of this protein in the blood. Heightened PSA levels can occur in BPH, prostatitis and prostate cancer. The test is not highly reliable, but it is considered to be more useful in detecting prostate cancer than BPH or prostatitis. Nevertheless, it's a part of the alphabet you should be familiar with. Urinary Flow Rate Measurement The patient urinates into a special device that measures how quickly urine is flowing. The peak flow rateÑwhen the urine is flowing fastestÑis a more specific indication of BPH than the average rate of flow. Ultrasound This is usually only used if there is a suspicion of prostate cancer. A probe in the rectum directs sound waves at the prostate, and echo patterns of those waves form an image of the prostate on a display screen. American Urologic Association Symptom Index The American Urologic Association has developed a symptom index (AUASI) that has become the standard test to assess symptoms of BPH. This symptom index is a series of questions that help determine the severity of urinary symptoms and is used by urologists around the country. If you are looking for any more specific information about how to tell if you have an enlarged prostate or what steps you need to take if you do, please feel free to visit our web site. natural penile enlargement exercise vimax herbal penis enlargement free penile enlargment tip free exercise tip for penis enlargment free natural penile enlargement vimax free penis enlargement technique herbal natural penis enlargement buy penile enlargment pills enlargement penis pills vimax

Erectile Dysfunction is a serious problem, which leaves a person with trauma about his future sex life. The dysfunction is accompanied by several other disorders that have adverse effect on the health of a person. A person may suffer from depression and anxiety that prohibit him from normal sexual activities. Erectile Dysfunction is a man’s inability to maintain or have an Erection. There are various factors that lead to Erectile Dysfunction in men. These factors are mostly physical in nature such as heart disease, diabetes, and Peyronie’s disease. However, there are certain psychological factors as well; these are: stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure. Curing a disease is imperative but if we can prevent the disease by taking some precautionary measures then we could get away with many problems and pains associated with the disease and rehabilitation. Erectile Dysfunction can be prevented to some extent if proper exercise is done regularly. Exercise is a healthy practice that will always keep you fit and healthy along with protecting you from major diseases and disorders. With the change in life style and increase in the age of a person, the problem tends to find its place in the weird body. Regular workouts must be accompanied by proper eating and drinking habits because consuming alcohol and smoking may cause Erectile Dysfunction. What can exercise do to your body? The best thing about exercise is that it doesn’t have any side effects and it is the safest and the best way to keep you fit. Studies have shown that people doing regular workouts do not suffer from Erectile Dysfunction. Workouts increase the flow of blood, which is essential for attaining and maintaining an Erection. People suffering from Erectile Dysfunction should burn at least 200 calories to stay fit and healthy. There are tests that can check the optimum flow of blood into the penis. Doppler ultra sound scanning is one of them. Choose your favorite exercise and start today · Walking is the best exercise any doctor would recommend. One hour of walking can bring you favorable results. · Jogging, cycling and gardening move your body to increase blood flow. · Pelvic exercises help control ejaculation. Apart from keeping you fit and protecting you from Erectile Dysfunction, exercise also gives a lot more to your body. · Regular exercise reduces weight loss and keeps you fit against problems related to obesity. · Exercise reduces the risk of cancer. · The feel good factor is always there with regular workouts. Precautionary measures There are some that you should remember while doing exercise. Exercising for a long time increases the blood sugar level, which can cause diabetes. Overdoing the exercise at the start may also cause problems. So, a patient should remain cautious and consult a doctor before starting the exercise program. Besides proper exercise, your food intake will definitely assist you in staying fit and healthy. Healthy diet in the form of fruits, green vegetables, grains and legumes would keep you sexually healthy. So, stay fit and keep away the diseases that harm and haunt you. penis enlargment result natural penis enhancement side effects magna rx penile enlargement fact guide to penis elargement penis enlargment surgery photo free pennis enlargement technique vimax penis enlargement secret enlargement penis pills vimax

Dial 1-800/AIDSNYC Every Monday and Wednesday morning, promptly at 10 a.m., I leave behind my daily life and turn to volunteering as an AIDS Hotline counselor at New York City’s GMHC [Gay Men’s Health Crisis], the nation’s largest social service agency for AIDS. For the next four hours, my co-volunteers and I sit in front of a bank of constantly-ringing telephones, talking to men, women, and teens who call in from across the nation with urgent questions about AIDS, the ravaging disease that has left 13.9 million people dead worldwide. After almost 20 years, a whole generation, families are still facing the heartache of tending the sick, while scientists continue to be confounded by this stubborn, ravaging virus. Although the federal government currently spends$4 billion per year on AIDS research, and $15 billion worldwide, there is no cure in sight for the viral infection and no vaccine available. Small wonder that the GMHC AIDS Hotline, the nation’s first, is flooded with more than 40,000 calls each year. Listening to callers 8 hours each week, I often think the Hotline is actually a direct link to the soul of callers--an anonymous forum that allows each to reveal secrets and fears that they might otherwise never discuss with anyone. A Morning in May This is the way it began: “Good morning, GMHC AIDS Hotline, can I help you?” “Yes...I have a question...[hesitantly] My son...he’s 21...and he just found out...he’s HIV-positive [voice breaking] I’m.....alone, divorced. And I need some help...someone to talk to...” “Of course....happy to talk to you...it sounds like this has been devastating for you....” “It’s terrible. He told me two nights ago....he’s...he’s so young....I don’t want him to die. He’s my only child....why did this have to happen?” [crying] Her son, she explains, had sometimes neglected using condoms, convinced he wouldn’t contract HIV infection from his female partners. “How could he be so stupid?” she now asks angrily. “Why didn’t he know how to protect himself? I don’t understand. What am I going to do?” We talk for 35 minutes, and by the end of the conversation, I notice I’m barely breathing. The distraught woman’s anguish is palpable. Her situation is every mother’s worst nightmare.The life of her child is in jeopardy and she feels helpless and afraid. I can’t imagine anything worse. During the call, I do my best to employ the GMHC Hotline protocol of “active listening,” which involves using silence, empathy and gentle probing with open-ended questions. I’m also having my own emotional reaction to the panic in her voice, and I’m worried about whether I’m doing enough. Toward the end of the clal, when she exclaims: “I don’t want my baby to die,” my heart plummets: “I know....I understand that, but there is hope,” I tell her. I find myself on the verge of tears. The Bad News This mother’s story is too common. According to the Centers for Disease Control in Atlanta, Ga., 40,000 Americans (half of them under 25) are newly infected with the AIDS virus each year. Unprotected sex and intravenous drug use remain the principal modes of transmission. “Teenagers,” notes AIDS activist Elizabeth Taylor, “are being very hard hit.” She refers to the three million adolescents who contract a sexually-transmitted disease annually. “Heterosexual teenage football players who are healthy and drink milk can get it too!” says the 71-year-old actress, who has singlehandedly raised $150 million for AIDS research. “But teens are very ignorant and feel invincible. They believe there’s an invisible shield protecting them from the virus, when it’s actually aimed right at them.” Taylor believes in addressing the problem head-on: “Tell your teenage son: ‘Maybe a condom doesn’t feel as good, but if it saves your life, it’s better than being six feet under.’ Intelligence must replace random sex.” Although a new generation of AIDS-fighting medications is prolonging the lives of thousands, nearly half of the 900,000 people infected with HIV in the U.S. cannot afford these drugs. Since the virus was discovered in l981, 410,800 Americans have died from AIDS-related complications, and the disease has left 13.9 million dead worldwide. Who Calls a Hotline? Not long ago I took a call from a 15-year-old boy living in a small town who said he feels guilty about his sexual attraction to other boys and is scared to discuss this with his parents. I ask him if there’s a school counselor or relative he might talk to, but he says he’s too afraid to confide in anyone. Being a teenager is hard enough, I thought, without the pressure of keeping this kind of secret. I felt angry and saddened that this child can’t comfortably discuss his feelings with his own parents. I encourage him to call the Gay Community Center Youth Program in a nearby city. In the meantime, I assured him that he could call our Hotline anytime, that we’d be there for him. This call was typical of the many we get from teenagers,whispering from their parents’ homes, confiding their blossoming sexual feelings and concerns. Our Hotline also receives calls from married men who phone from their offices, worried about extramarital sexual encounters; gay men suffering side effects from medications; mothers caring for a sick child or grieving for one lost to AIDS; even health care professionals themselves confused and requiring burnout support. One particular morning, I’m struck by the number of single women who turn to our hotline for help. At 10:15 a.m. a distraught young woman calls, explaining that she had been dating someone “very charismatic,” after a two- year period of sexual abstinence. “At first we used condoms and I was taking the pill to avoid pregnancy,” she says. But after her partner assured her he was HIV-negative, the couple began having unprotected sex. A few months into the relationship, she recounts, his behavior became “unpredictable,” until he finally admitted he was sleeping with other women and was addicted to heroin. Now she has to withstand the “terror” of waiting 3 months before getting an HIV antibody test. To help her cope, I give her the names of three terapists in her area. The call lasts 43 minutes. At 11:15 a.m. I take a call from a woman who is breathing heavily. She says that four months earlier she’d had a brief affair with a limousine driver, “not out of passion, but because I felt lonely. This was so totally unlike me,” she continues. “I come from a traditional Orthodox Jewish family...” Although they used condoms, and she has since tested negative for HIV, she feels deeply ashamed, and has stopped seeing him. And because she has both a persistent vaginal yeast infection and a rash on her neck, she’s convinced she must be infected by HIV. Although rashes, high fever, swollen lymph glands, heavy night sweats, sore throat, or other flu-like symptoms may indicate HIV, they can just as easily accompany the common cold or flu, or other type of infection. I encourage her to seek medical help and counseling, but the calls ends on a down note. “I must have it [AIDS],” she moans. I’m exasperated because it doesn’t sound that way to me, yet I can’t get through to her. The call lasts 22 minutes. It’s 11.38 a.m. when a well-spoken woman, who says she’s an attorney, calls from her office, asking for the names of anonymous testing sites. At first very businesslike, she calmly takes down all the information. I ask her why she’s considering a test. Total silence. Then she begins to cry: “I....I can’t talk....I’m sorry...you see, I have swollen lymph glands....[crying]....And my doctor wants to rule out HIV...I feel overwhelmed...” Then, abruptly: “Where can I send a donation?” She thanks me and hurries off the phone after just 3 minutes. These were one-time callers, but, as in any epidemic, an element of panic prevails, and our hotline also attracts an army of “chronic” or repeat callers who are intensely fearful no matter how benign their risk, many revealing continued misconceptions and paranoia about a disease that can be effectively prevented. We do our best to help them, but often they’re impervious to counseling. Most poignant are calls we get from AIDS patients, phoning from their hospital beds, attempting to navigate the exhausting labyrinth of insurance and health care matters. One man, in hospice care, said he craved companionship and missed the “good old days” when he was handsome and healthy. That call was a tough one for me as just the day before a close friend of mine, Joe, who had battled HIV for 16 years, had finally succumbed. Although at the end Joe was a mere skeleton, he was nonetheless at peace. “I’ve done what I wanted to,” he told me on our last visit. An avid gardener, he insisted on a final trip to his country house to see his garden one last time. For a moment the caller’s reality and the memory of my deceased friend blurred in my mind and I was overcome. Time for a break. Face to Face One of the most and unique services GMHC offers is called “A-Team Counseling,” a one-time, in-person session that’s free and anonymous. Recently, I was on an A-Team counselling a 26-year-old HIV-infected mother from the Midwest. She had traveled to Manhattan by bus to find her estranged boyfriend, who, she recounted tearfully, had kidnapped her 7-year- old son. Disheveled, painfully thin, the woman was a disturbing sight. She’s learned that the two had already returned home where the boyfriend was, and the child put in his grandmother’s custory. custody of his grandmother. Meanwhile she’d run out of money for the return trip, been refused a loan by her family, lost her ID, gone hungry and spent two nights on the street. Fortunately, this woman was registered at a local AIDS organization in her town. I telephoned her caseworker and persuaded him to buy her a one-way Greyhound bus ticket for $115.00. I also gave her subway tokens, a basket of food, juice and coffee. Smiling shyly, she thanked me for caring. Shaking hands good-bye with this woman was a bittersweet farewell. What will happen to her? I wondered will her health deteriorate or improve? Will she gain control of her life and be able to provide for her son? I’ll never know. One thing I do know: She’d appeared with the sorrow of a difficult life in her eyes, but when she left, she was elated at the thought of being reunited with her child. It seems that with faith and a helping hand, almost anything is possible. * * * * * 10 BIGGEST MISCONCEPTIONS ABOUT AIDS AND HIV (This list would probably be most effective when presented in a vertical chart, the misconception on the left, the correct answer on the right.) 1)The AIDS virus can be transmitted through saliva, sweat, tears, urine or feces; also through deep kissing. 1) HIV can ONLY be transmitted through four bodily fluids: blood, semen, vaginal secretions and breast milk--and can also be transmitted from a mother to her child before birth, during birth, or while breast feeding. The exchange of saliva through kissing is no-risk, unless the saliva has blood in it and both you and your partner are bleeding in the mouth simultaneously. 2) HIV may also be transmitted through casual contact with an infected person. 2) You can’t get infected from toilet seats, phones or water fountains. The virus can’t be transmitted in the air through sneezing or coughing. You can’t get HIV from sharing utensils or food or from touching, or hugging. HIV dies after being exposed to the air. Therefore, touching dried blood on a shaving blade, a toothbrush or a bathroom counter top is no risk. In any case, unbroken skin is impermeable, like a rubber raincoat, and cannot absorb the virus whether it’s alive or dead. Blood transfusions and medical procedures in the U.S. are safe. Giving blood is completely risk-free. The chance of getting HIV from dentists or other health care providers is too low even to measure.You can’t get it from mosquitoes or other insect or animal bites. 3) Oral sex is just as risky as vaginal or anal intercourse. 3) Although not 100% risk-free, oral sex is considered a low-risk activity,except if: you have bleeding gums, recent dental work, open sores such as a herpes lesion, any cut, blister, or burn in the mouth, or if you’ve just brushed or flossed your teeth. Also, oral sex with an infected woman is riskier if she is having her period, since menstrual blood can contain HIV. Overall, latex barriers, (such as condoms or dental dams) used during oral sex reduce the transmission of not just HIV, but other sexual transmitted diseases. 4) Animal skin, latex and polyurethane condoms are all equally effective in preventing HIV infection and you can use ANY lubrication on the condom desired. 4)Only latex or polyurethane condoms may be used, as HIV can pass through an animal skin condom. With latex condoms, only water-based lubricants--like K-Y jelly or H-R jelly--may be used. No lubricants with oil, alcohol, or grease are safe.Petroleum jelly,Vaseline, Crisco, mineral oil, baby oil, massage oil, butter and most hand creams can weaken the condom and cause it to split. However, with polyurethane condoms, petroleum-based lubricants can be used. 5) Women have to rely on men using condoms during intercourse to protect themselves against HIV. 5) Women may employ the “female condom,” a plastic sheath that can be inserted in their vaginas and used for protection against HIV. It can be inserted up to 8 hours before sex, has rings at both ends to hold it in place and can be lubricated with oil-based lubricants that stay wet longer. In addition, women can carry conventional condoms for their male partners’ use. 6) If a woman is HIV-positive, her offspring will automatically be born infected with HIV. 6) With no medical treatment taken, about 25% of HIV-positive women will give birth to infants who are also infected. However, the use of anti-HIV medications has resulted in a significant decrease of mother-to-child transmission of HIV in utero and during delivery to less than 5%. (NYT 10/19/ 99]. 7) AIDS is fundamentally a gay disease contracted by white males. 7) Recent data compiled by the Centers for Disease Control and Prevention indicate that young gay Hispanic and African-American men and heterosexual women are the fastest growing segment of the population being infected with HIV. Women now account for 43% of all HIV infected people over age 15. [NYT 11/24/98] African-American and Hispanic women account for more than 76% of AIDS cases among women in the U.S. 8) Heterosexual men are not really at risk for contracting HIV, even if they don’t use condoms. 8) The inside opening of the penis is composed of highly-absorbent, sponge- like mucous membrane tissues, which can provide a route for HIV-infected vaginal secretions or blood to enter the bloodstream. Proper condom use protects men from infection. 9) The AIDS epidemic is largely over because new AIDS medications like protease inhibitors and others have turned AIDS into a chronic, not a terminal disease. 9) In the U.S., AIDS is the fifth leading cause of death for people 25-44 years old. Roughly half of all those infected with HIV in the U.S. are not receiving any medications or medical care. AIDS now kills more people worldwide than any other infection, including malaria and tuberculosis.[NYT 11/24/98] In 1998 alone, 2.5 million people died of AIDS worldwide. 13.9 million people have died since the virus was discovered in 1981. 10) If you think you’ve been exposed to HIV through unprotected sex, you can take an HIV antibody test 2 weeks later and get an accurate result. 10) The standard “window” or waiting period remains a full 3 months. However, because the widely-used HIV antibody tests (The ELISA and Western Blot) have become so sensitive, about 95% of people will procure an accurate result 4-6 weeks after a possible exposure to the virus. * * * * [Note:The information stated above was reviewed for medical accuracy by Dr. Todd J. Yancey, an infectious disease specialist practicing in New York City and affiliated with New York Presbyterian Hospital, NY, Cornell Campus.] THE CHILD LIFE PROGRAM “Mommy takes a lot of medicine and Mommy’s really tired sometimes and she can’t take you to the park as much as she used to. It’s not that I don’t love you...and that I don’t want to...but Uncle Jack’s going to take you to the park today.” --A mother living with AIDS, a client at GMHC, talking to her 6-year- old son. In New York City alone, 28,000 children have been orphaned by AIDS since the epidemic began [NYT 12/13/98] GMHC’s unique Child Life Program serves HIV-infected parents and their children--who may, or may not, be infected with the virus. “We help families strengthen their ability to cope, relieve the pressure of parenting with support services, and teach parents how to talk to their kids,” says Child Life Program Coordinator Alison Ferst. “Unfortunately, should a parent or child be sick enough to be facing death, we also help them walk through it with grace and dignity---as opposed to feeling alone, isolated and frightened. “We also encourage sick parents to make stable legal plans for their children who may be left behind,” adds Ferst, “and to have disclosure conversations with the children in advance, so you don’t have a child standing at her mother’s funeral, not sure where she’s going next.” When an HIV-infected Mom arrives at GMHC to have lunch, attend a support group, consult with a lawyer, or access the acupuncture clinic, she can leave her children in a spacious playroom, decorated with fanciful murals and a giant tree hand-painted by the famed children’s story writer and illustrator, Maurice Sendak, who donated his art. [see photos] The program provides: child- sitting, nutrition services, a food pantry, art and magic classes, and recreational trips--church picnics, seasonal apple-pumpkin picking, amusement parks, zoos, museums, beaches. Also: homework help sessions, holiday parties, hospital visits, summer sports and weekly support groups for HIV- positive parents and their HIV-negative children. This unique program also features: Cooking classes for kids who sometimes prepare meals for sick parents; Pediatric Buddies, GMHC adult volunteers who play with sick children and also assist with family chores; Fun With Feelings Support Group, Friday Evening Family Time, Birthday parties, and a Holiday Gift Drive. “Children infected or affected by AIDS,” concludes Ferst, “want to be like other kids: They want to play with their friends, want to know that someone will always take care of them, want to know they’re not alone, and often wonder if it’s their fault when Mom or Dad gets sick.” These children need a helping hand and any of us can provide one.