SOIL AND SHOWER OF HIV / AIDS IN INDIA

SOIL AND SHOWER
HIV(seed)
OF
HIV / AIDS IN INDIA
DISCUSSION FROM A DIFFERENT ANGLE
HOST
(SOIL))
ENVIRONMENT
(SHOWER)
Dr. A.K.AVASARALA, MD
PROFESSOR & HEAD
DEPARTMENT OF COMMUNTIY MEDICINE AND
EPIDEMIOLOGY
PRATHIMA INSTIUTE OF MEDICAL SCIENCES,
NAGUNUR, KARIMNAGAR ( A.P.), INDIA – 505417.
E_mail : avasarala@yahoo.com
HIV INFECTION
NO DOUBT IT

INVADED

SETTLED

SPREADING IN INDIA

UNAIDS FACT SHEET 2003
HETEROSEXUALS ( SEX WORKERS )-60-70%
ANTENATAL WOMEN - 1 %
HOMOSEXUALS – 27 % ( NACO, INDIA)
HIV/AIDS IN INDIA
HETEROGENEOUS DISTRIBUTION
• GENRALIZED
• EPIDEMIC
•
•
•
>5% in high risk groups+ >1%
IN PREGNANT WOMEN
MAHARSHTRA,TAMILNADU,KARNATAKA,
ANDHRA PRADESH,MANIPUR
CONCETRATED
EPIDEMIC
(>5% IN HIGH RISK +<1%
PREGNANT WOMEN
GUJARATH,GOA,KERALA,WESTBENGAL
NAGALAND
•
LOW LEVEL
EPIDEMIC (<5% IN
HIGH RISK+<1% IN
PREGNANT WOMEN
UTTAR PRDESH,MADHYA
PRADESH,BIHAR,RAJASTHAN
REST OF INDIA
vulnerable WITH HIGH
STD
PREVALENCE
HIV/AIDS IN INDIA
• HR > 5 , PW > 1%
MAHARASHTRA,TAMILNA
DU,KARNATAKA,ANDHRA
PRADESH,MANIPUR
• HR > 5% , PW < 1%
GUJARATH,
GOA,
WESTBENGAL,
NAGALAND
• HR < 5% , PW < 1%
UTTARPRADESH,MADHYA
PRADESH,BIHAR,
RAJASTHAN
SENTINEL SURVEILLANCE DATA
IN METROPOLITAN CITIES
RURAL SITUATION
ALSO NOT SATISFACTORY
MORE HIV SEEN
DUE TO POOR LITERACY & UNAWARNESS
AND LESS CONDOM USE
3 EPICENTRES
1.
MEGHALYA, MANIPUR & MIZORAM
2.
MAHARASTRA
3.
ANDHRA PRADESH & KARANATAKA,
AND TAMILNADU
EPICENTRE -1
(SOIL &SHOWER)
MEGHALAYA, MANIPUR AND MIZORAM
FERTILE SOIL(SUSCEPTIBLE HOST)
POOR AND UNEMPLOYED
YOUNG AND IMMATURE, ANTISOCIAL
TEMPTED TO INJECTABLE DRUG ABUSE
CALLOUS , HENCE CONTAMINATION OF NEEDLES
SHOWER (FAVOURABLE ENVIRONMENT)
FREE AVALIBILITY OF NARCOTIC DRUGS DUE TO
DRUG TRAFFICKING ACROSS THE MYANMAR BORDER and
POLITICAL INSTABILITY favors HIV INFECTION
? CAN FREE SUPPLY OF STERILE NEEDLES
SOLVE THIS PROBLEM ? IS IT ETHICAL?
CONFOUNDING SITUATION
AT MIZORAM
VIOLENCE
POLITICAL INSTABILITY
FALSE SECURITY
FALSE COURAGE
UNEMPLOYMENT &
IDLE YOUTH
HALLUCINATIONS
DELUSIONS
DRUG ABUSE&
HIV
FREELY AVAILABLE
DRUGS
EPICENTRES-2&3 (SOIL &SHOWER)
MAHARASTRA, ANDHRA PRADESH, TAMILNADU,
KARANATAKA
SOIL
UNSAFE SEX , ILLEGAL SEX
COMMERCIAL SEX WORK
MULTIPLE SEX PARTNERS
LESS CONDOM USE
SHOWER
POVERTY,
MUMBAI,PUNE,SATARA.CHENNAI,
VIJAYAWADA(AP)
HUNGER, ILLITERACY,
WITH THEIR GROWING URBAN SLUMS
AND MOBILE POPULATION,
CARELESSNESS, SEXUAL
PERVERSIONS
COMMERCIAL SEX WORK(CSW)
LACK OF BROTHEL LICENCING,
LACK OF MEDICAL EXAM FOR CSW
EPICENTRES 2&3 DHABHAS
(WAYSIDE FEEDING CENTRES OF ILLFAME)
OTHER SIDE OF THE COIN
•LONG DISTANCE
TRUCK DIVERS
•LEAVING THEIR
WIVES AT HOME
LONELINESS,
RESORT TO ILLICIT CHEAP
SEX
AT DHABHAS
HIV
SEEDLING ALONG
HIGHWAYS
BIG BUSINESS
•CONTRACTORS ENOLL
SEXWORKERS AND DROP
THEM AT DHABHAS IN THE
EVENING AND COLLECT
THEM IN THE MORNING
THEY COLLECT
COMMISSION FROM CSW.
•DHABHA OWNER IS ALSO
BENFITED DUE TO MORE
NUMBER OF CUSTOMERS
WEAK ENFORCEMENT OF
RESTRICTION OF IMMORAL
TRAFFIC ACT IS ANOTHER
FACTOR.
WHY HIV INVADED&SETTLED INDIA
INDIAN SOCIETY CHANGED IN
FAVOUR OF
-
HIV
5
HIV / AIDS IN INDIA
IS
NOT
JUST DUE TO
HIV ALONE (THE SEED)
SOCIETAL CHANGE (SHOWER)
•ACCULTURATION
EFFECTS
INCREASE IN -VE LIFE
STYLES REGARDIG SEXUAL
PRACTICES
•CULTURAL CHANGES--
•DETERIORATED HUMAN VALUES
•SEXUAL PERVERSIONS AND STD ON THE RISE
•COSMOPOLITAN NATURE OF CITIES ENCOURAGING -VE
LIFESTYLES
•URBAN SLUMS & NIGHT CLUBS -MORE OPPORTUNITIES FOR
ILLEGAL AND UNSAFE SEX
•INCREASING MOBILE POPULATION AT BUSSINESS CENTRES AND
CITIES FAVOURING THE SPREAD
•COMPLACENCY ABOUT UNIVERSAL PRECAUTIONS &SEXUALLY
TRANSMITTED DISEASES
DETERIORATION
MONOGAMY
AT THREAT
HUMAN VALUES &VIRTUES
AT LOW LEVEL
CELIBECY NOT PRACTICED
INCREASING SEX ABUSE
ESPECIALLY IN COSMOPOLITAN
CITIES
DUE TO
•
FREE AVAILABILITY OF SEX
•
COMMERCIAL SEX WORK AND SEX
MARKETTING
•
NIGHT CLUBS AND CALL GIRL
SYSTEM
•
ILLEGAL SEX
•
MULTIPLE PARTNERS
SEXUAL
•
PERVERSIONS
HIV IS A MAJOR
BEHAVIORAL PROBLEM
•
HOMOSEXUALITY -- INCREASE IN
•
THE LONELY
•
ORAL SEX
•
ANAL SEX- CHILD ABUSE
CONTROL ASPECTS
SPREAD OF HIV
CSW
&INJECTABLE
DRUG
USERS(IDU)
(HIGH RISK)
GENERAL
CLIENTS OF CSW,
STD PATIENTS,
PEERS OF I.D.USERS
(BRIDGE)
POPULATION
HIV (THE SEED)
WHY HIV IS PREFERRING T4 CELLS
ONLY NOT OTHER CELLS
WHAT IN T4 CELLS THAT IS
ATTRACTING HIV ?
CAN THAT SOMETHING CAN BE
ELIMINATED OR NEUTRALIZED ?
LIFE STYLE MODIFICATIONS-TOP
PRIORITY
“ MEND
THE MIND MUST BE THE
RULE AS HIV IS MAINLY A
BEHAVIORAL
DISORDER
LIFE STYLE MODIFICATIONS ARE NOT GIVEN
ENOUGH STRESS AT PRESENT
ETHICAL VALUE OF SAFE SEX NOT MUCH
EMPHASIZED
CHARACTER-BUILDING NOT ATTEMPTED
NO STRESS TO CURB DON’TS (-VE LIFE STYLES )
LIFE STYLE MODIFICATIONS
ONLY THE CHANGE OF BEHAVIOR
CAN SOLVE THE HIV PROBLEM
PERMANANTLY
IT IS NEITHER ADVISABLE NOR ETHICAL TO
PROVIDE STERILE SYRINGES FREELY TO A DRUG
ADDICT AND ASK HIM TO CONTINUE TO TAKE
DRUGS NOR TO PROVIDE A CONDOM AND ASK TO
VISIT A BROTHEL, BECAUSE IN BOTH THE
STRATEGIES, BEHAVIOR AL CHANGE TO
CURB RISKY BEHAVIOR WILL NOT OCCUR
BUT WILL CONTINUE. .
MIZORAM HIV CONTROL
•
CONFOUNDING SITUATION
•
BRINGOUT THE BEHAVIORAL CHANGE AMONG
RISK GROUPS ESPECIALLY THE YOUTH
•
USE DEADDICTED PATIENT FOR MOTIVATION
NEW ADDICTS
HIGH
OF
•
SCHOOL CURRICULAM TO INCLUDE THE
ADVERSE
EFFECTS OF THE DRUG ABUSE AND CONTAMINATED NEEDLE
USE
•
CONTROL DRUG TRAFFICKING ACROSS
BORDER
•
MYANMAR
REDUCE THE FREE ACCESSIBILITY AND
AVAILABILITY OF DRUGS
•UTILIZE PEERS (YOUTH ) TO BRING CHANGE IN YOUTH
MIZORAM HIV CONTROL
• PROVIDE EMPLOYMENT FOR YOUTH
•
FREQUENT RECURRENT VIOLENCE
LEADS TO INSECURITY ,DESPAIR
AND THEREBY RESORTING TO DRUG
ABUSE.
•
DRUG INDUCED HALLUCINATIONS
GIVE FALSE SECURITY AND FALSE
COURAGE WHICH INTURN BREEDS
VIOLENCE-
•
STEPS TO REDUCE VIOLENCE BY
EDUCATING THE PEOPLE ABOUT
EPIDEMIOLOGY OF VIOLENCE
MIZORAM HIV CONTROL
•
CONTROLLING DRUG
TAFFICKING ACROSS THE
BORDER,
•
STRICT VIGILANCE OVER DRUG
TRAFFICKERS,
•
INCOME GENERATING
ACTIVITIES FOR
UNEMPLOYED YOUTH,
•
PERSISTATANT PERSUAVASSIVE
METHODS TO REDUCE IV DRUG
USE
HIV CONTROL AT EPICENTRES 2&3
(MAHARASHTRA,ANDHRA PRADESH,
TAMILNADU &KARNATAKA)
COMMERCIAL SEX WORK AND HIV CONTROL
LICENCED BROTHELS WITH REGULAR SCREENING
AND TREATMENT FOR STD ,
INCOME GENERATING ACTIVITIES FOR CSW,
REHABILITATION OF THE CHILDREN AND DEPENDENTS
OF CSW,
STRICT ENFORCEMENT OF IMMORAL TRAFFIC
REGULATION ACT
STRICT VIGILANCE
AND SCREENING FOR HIV
AT
DHABAS &
NIGHT CLUBS
CONDOM USAGE
CONDOM USAGE IS A TEMPORARY INTERVENTION . IT IS ALSO NOT
ETHICAL TO GIVE SOMEONE A CONDOM AND ASK HIM TOVISIT A
BROTHEL . IN THE LONG RUN, IT WILL NOT HELP.
BUT IT IS A MOST PRACTICAL AND FEASIBLE INTERVENTION BUT
WHY IT IS USED LESS ?
WHY LESS ACCEPTABLE?
SEX WORKERS COMPLAINING THAT THEY ARE LOOSING THEIR
BUSINESS IF THEY INSIST THEIR CLIENTS FOR CONDOM USE .HOW
FAR IT IS TRUE?
HOW TO IMPROVE COMPLAINCE OF CONDOM USAGE?
I.E.C. ACTIVITIES HAVE TO BE MODIFIED TO ENHANCE CONDOM
USAGE AND COMPLAINCE.PEER GROUP MOTIVATION MAY BE TRIED
CONDUCTING EXHIBITIONS SHOWING VARIOUS MODELS AND
SPECIMENS OF SEXUALLY TRANSMITTED DISEASES MAY CREATE
INTEREST IN THE PUBLIC AND BECOME SENSITIZED FOR CONDOM
USE.
MCTC AND THROUGH INFECTED BLOOD
•
MOTHER TO CHILD TRANSMISSION (MCTC)
•
•
•
AS HIV IS HIGH IN ANTENATAL WOMEN (1%) ,
IT IS NECESSARY TO PREVENT MCTC.
PREVENTION TRIALS ARE UNDERWAY IN
ANDHRA PRADESH
•
HIV THROUGH INFECTED BLODD HAS COME DOWN
INDIA DUE TO
CLEARCUT TRANSFUSION POLICY
STRICT LICENCING OF BLOOD BANKS
AVOIDING BLOOD COLLECTION FROM
PROFESSIONAL DONORS
•
•
•
LESS EFFECTIVE CONTROL FIRST GENERATION STD
IN INDIA, CONTROL OF SEXUALLY TRANSMITTED DISEASES WAS NOT
SERIOUSLY CONSIDERED THINKING THAT THEY ARE OF PERSONAL IN NATURE
CLINICS FOR VENEREAL DISEASES WERE STARTED VERY MODESTLY
.
HIGH LEVEL SECRECY WAS MAINTAINED REGARDING STD,HENCE POOR
PUBLIC AWARENESS AND INTURN LEAD TO RUMORS AND SUPERSTITIONS
e.g. INTERCOURSE WITH A CHILD WILL RELIEVE STD &
OPEN AIR URINATION CAUSES GONORRHEA
TALKING ABOUT STD ITSELF USED AS A SIGN SOCIAL DEMORALISATION
SCREENING FOR STD IN HIGH RISK GROUPS AND TREATING THE CASES WILL
REDUCE THE VULNERABILITY FOR HIV AND THEREBY HIV INCIDENCE
STD SYNDROMIC MANGEMENT SHOULD BE REALLY PRACTICED IN THE FIELD
STD CONTROL AS IT IS INCLUDED IN NATIONAL AIDS
CONTROL IS NOT GETTING ENOUGH ATTENTION
•
AIDS CONTROL SOCIETIES
•FOR COMMUNITY INVOLVEMENT
•
HOW FAR THEY ARE SUCCESSFUL
•IN REDUCING THE HIV INFECTION?
•COMMUNITY PARTICIPATION HAS NOT REACHED ITS DESIRED LEVEL .
•AS EVIDENCED BY
•INCREASE IN HIV INFECTION
•POOR USAGE OF CONDOMS
•POOR AWARENESS AMONG BOTH URBAN AND RURAL POPULATION
•ENRICH AND JUVENATE COMMUNITY INVOLVEMENT EITHER BY
INCENTIVES OR DISCENTIVES.OR BY STRICT LEGISLATION
•COORDINATION COMMITTEES SHOULD NOT BE CONFINED TO PAPER.
•REAL INTERSECTORAL COORDINATION WITH RESPOSIBILITIES,WHICH ARE
ACCOUNTABLE AND MONITORABLE, TO BE FIXED ON ALL SECTORS
MASS MEDIA
STRONG POSITIVE ROLE ESSENTIAL
TV 9 CHANNEL INTERVIEWED CSW AT EAST GODAVARY
DIST (AP) . CSW COMPLAINED THAT THEY ARE LOSING
THEIR CLIENTS DUE TO HIV?
FLIMS -SOME MOVIES ARE GIVING FALSE MESSAGES
ABOUT HIV TRANSMISSION THROUGH THE COMEDIANS.
EVEN FOR JOKE, WRONG MESSAGES SHOULD NOT BE
GIVEN AS THEY BREED RUMORS AND SUPERSTITIONS AS
HALF OF THE INDIAN COMMUNITY IS ILLTERATE.
SUICIDES AFTER HIV POSITIVE DECLARATION ARE STILL
HAPPENING.EFFECTIVE POST-TEST COUNSELLING IS
IMPERATIVE
CONCLUSION
AS IT IS SECOND GENERATION STD, IT
TACKLING AT PERSONAL LEVEL FIRST
AS IT IS A LIFE STYLE DISEASE
MODIFICATIONS ARE ESSENTIAL
NEEDS
, LIFE STYLE
AS LONG AS FAVORABLE ENVIRONMENT AND
SUSCEPTIBLE HOST IS AVAILABLE IT WILL BE
SPREADING.HENCE NEED FOR STRESS ON LONG
TERM STRATEGIES INSTEAD OF TEMPORARY
BENEFITS
TREATING AIDS PATIENTS IS ONLY HALF OF THE
ANSWER
AGRESSIVE HEALTH EDUCATION AT SCHOOL LEVEL
(PRIMORDIAL
PREVENTION
)
IS
RIGHT
INTERVENTION BEFORE FIXED IDEAS DEVELOP.