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HIV/AIDS: Indian Context

By Davendra Sharma


AIDS (Acquired Immunodeficiency Syndrome) is a disease caused by HIV (Human Immunodeficiency Virus) infection which affects our immune system. However, every HIV positive person is not an AIDS patient. An AIDS patient is one in whom CD4 T helper cell count is less than 200 cells/uL. People having AIDS are prone to a number of infections, which become life threatening due to failure of immune system.  Usually there is long time span of about six to ten years or even more between getting infected and surfacing of disease. HIV is usually transmitted by unsafe sex with an already infected person, contaminated blood transfusions/hypodermic needles and from mother to child during pregnancy, delivery or breast feeding.

Origin of the disease is unknown though it is mostly believed that the virus had existed in African primates like chimpanzee from where it got transferred to some of the African tribes who came in contact with these primates. Every epidemic needs certain conditions to spread. In case of AIDS these conditions became available in the later part of the 20th century. Migrant working population, breaking up of traditional societies and changes in sexual behavior of the people provided suitable conditions for the growth of this disease. The disease is more dangerous than other epidemics because till date no cure or vaccine has been developed for this disease; therefore the disease can only be prevented but not cured.

Situation in India

First case was detected in India in 1986 among female sex workers of Chennai. The number of patients rose sharply till 2002 but after that the number has been stable and even shown a little decline in the last few years. As per Annual Report of National Aids Control Organization, though India is a country with low HIV prevalence, it has third largest number of patients living with HIV/AIDS. As per HIV estimates for the year 2008-09, 23.9 lakh persons were living with this infection at an adult prevalence of .31%. These estimates also tell that about 1.72 lakh people died of HIV/AIDS during the year. Six states which have prevalence rate of above 1% have been categorized as High prevalence states. These states are Andhra Pradesh, Maharashtra, Karnataka, Tamil Nadu, Manipur and Mizoram and between themselves these account for 57% of the total cases.

Four categories of persons have been targeted as ‘High Risk Groups(HRGs)’ which are Female Sex Workers, Men who have sex with men, Transgender and Injecting Drug Users. HIV is transmitted from these people to ordinary population through ‘bridge population’ which comprises of truckers and migrant workers. About 86 percent HIV incidence in the country is from unprotected sex. Perinatal transmission of the infection is 2.72 percent, whereas 2.57 percent HIV infection is due to transfusion of infected blood or blood products. Though HIV transmission through injecting needles is only 1.97 percent of overall prevalence, it is the major route of the infection transmission in the north-east region.

Measures taken by the Government

  1. Consequent upon the detection of first case in 1986, National Aids Committee was constituted in the Ministry of Health & Family Welfare. With the increase in the number of patients in the next few years, a need was felt to develop a specific programme. Consequently, National Aids Control Programme (NACP)-I was launched in 1992 and an autonomous body, the National Aids Control Organization (NACO) was formed to implement the programme. Presently NACO is the Nodal Agency for dealing with matters relating to HIV/AIDS at the national level while at the state level State Aids Control Societies have been formed to shoulder the responsibility.
  2. In the first phase of NACP stress was laid on development of infrastructure. 685 Blood banks and 40 component separation units were set up. 504 STD clinics were also set up with the help of government hospital and medical colleges for treatment of sexually transmitted diseases. HIV sentinel surveillance system was also initiated to detect cases in the high risk groups. NGOs were also involved though mainly for the purpose of awareness generation.
  3. During the second phase of the programme, new initiatives were taken through NGOs with specific focus on high risk groups and bridge population. These interventions included Behavior Change Communication, management of STDs and condom promotion. Awareness generation programme was extended to schools and about 93000 schools were covered in this phase. 101 Anti Retroviral Treatment (ART) were set up in selected hospitals in which 47,693 patients were treated. An important development was the constitution of National Aids Council, chaired by the Prime Minister and represented by 31 ministries and 6 high prevalence states.
  4. The third phase of the programme was launched with the objective of stopping and reversing the spreading of HIV by adopting the strategy of prevention, care & support and treatment. It was recognized that as prevalence of infection is more in the high risk groups and majority of the population is free from infection, prevention by creating awareness about the risk factors is the best way for stopping the spreading of this disease. Further, also understanding the needs of the Patients Living with HIV and AIDS (PLHA), ART facilities were made available free at public health facilities to all those who need them. 
  5. As a result of these concerted efforts, the problem has been slowly but steadily on the decline. Over the years the number of newly infected persons has come down from 2.71 lakhs in 2000 to 1.21 lakhs in 2009. Due to disease surfacing many years after infection, number of annual deaths reached the highest figures of about 2 lakhs in the year 2006 but has declined since then and is 1.72 lakhs for the year 2009. Similarly, number of PLHAs touched a maximum of 26.05 lakhs during the year 2003, but has also declined since then the figures for 2009 being 23.9 lakhs.  

Problems faced by HIV/AIDS patients

  1. The disease surfaces after a considerable time after the infection. During this period the patient knows nothing about the disease and no treatment is taken for the same. Usually the treatment is started when the disease has already done considerable harm. ART does reverse the damage already caused to the body, it only slows further degeneration. Arthur Ashe was an American Tennis player.  He was the only black player to have won Wimbledon, US Open and Australian Open Championships. Ashe got infected with HIV during blood transfusions during a heart surgery in 1983. The disease was detected in 1988 on account of his illness. He died from AIDS related pneumonia in 1993.
  2. During this period of latency, the infected person transfers the infection to his spouse and sometimes to the children born during the period.  This strains mutual relations and brings more agony to the family.
  3. Patients are usually discriminated by the society. The discrimination comes from a number of factors. First and foremost is the limited knowledge about AIDS. Many people believe that the disease is contagious and they can get infected by routine activities like touching, sharing food etc. with an infected person.
  4. Some private hospitals are reluctant to treat such patients due to the risk of getting infected. Even if the treatment is provided, it is so costly that the patients, who are mostly from poor backgrounds, are not able to afford it.
  5. AIDS affects people at the time when they are in prime of their productive capacity. This adversely affects the well being of the family.
  6. As the disease spreads mostly through sexual contact with an infected person, people consider the patient as immoral and treat him with contempt and ridicule.
  7. The patient lives in constant fear of death. This coupled with contempt and discrimination makes him prone to psychological disorders which adversely affect his life.

​Challenges in eliminating HIV/AIDS

  1. It is said that prevention is better than cure. In the case of HIV/AIDS, prevention is the only cure. Anti Retroviral Therapy can increase only reduce the impact of the disease but cannot cure it. Following steps can help in the prevention of this disease:
  2. Awareness generation and information dissemination about the practices which can cause HIV infection should be taken up on a large scale so that proper information is available to the public.
  3. Blood Banks should be regulated and it must be ensured that every unit of blood is screened for HIV. For obtaining blood, preference should be given to voluntary donors and professional donors should be avoided.
  4. Female Sex Workers, Men who have sex with men and Transgender are High Risk Groups due to unsafe sex practices. However, many of these are forced to indulge in these activities because of their vulnerability and adverse circumstances. Welfare schemes for these groups need to be taken up so that they are not forced to resort to these practices for their living.
  5. HIV screening for pregnant ladies should be made mandatory and if found positive necessary steps should be taken to prevent the child from being infected.
  6. Illegal drug are the main cause of HIV transmission through injecting drug needle. This is important in case of India as we are situated between two drug producing regions, Golden Crescent and Golden Triangle and also have some local production. Strong action needs to be taken to stop entry and circulation of these drugs in India.
  7. Proper sex education should be provided in schools so that the students are aware of risks involved in indulging in such activities.

 

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