MEDICAL STUDENTS
SPEAK
Responding to the AIDS
epidemic in India
Prashant Vaishnava,
Ashir Kumar
Since the first case of HIV infection was reported
in India in 1986, AIDS has devastated the country with approximately four
million cases currently (1).
Social empowerment
Though prevention is more cost-effective than
treatment (2-4), 48.6% of pregnant women surveyed in New Delhi preferred to get
information on AIDS from doctors rather than the mass media (5), 39.3% of the
subjects had not even heard of AIDS; only 45% were aware that AIDS is not
transmitted by mosquito bites (5). Clearly, there is an unmet demand for HIV
risk assessment and prevention counselling.
Samraksha (a Bangalore-based non-governmental
organisation) and ActionHealth (a UK-based charity) joined hands to form a Well
Woman Clinic in 1997 (6). The clinic operates on a walk-in basis on two
afternoons per week. Gynaecological examination, along with screening and
treatment is done for gonorrhoea, and infection with Chlamydia and Trichomonas
vaginalis. Each patient is then interviewed by a trained health advisor who
discusses safer sexual practices and distributes condoms with detailed usage
instructions. Management of partners is discussed and arranged, when
appropriate. The emphasis is on risk reduction.
Solomon et al. have identified some factors that
make Indian women vulnerable to HIV infection: the culture of silence
surrounding women's sexuality, the willingness to risk acquiring HIV to conceive
a child, and the inability to negotiate safer sex practices (7). Primary
prevention delivered through routine clinical encounters thus offers a means of
reaching out to a particularly vulnerable population.
Community mobilisation
Another primary preventive intervention is more
localised and aimed at mobilising community members. VISIONS Worldwide, Inc.,
formed in 1995, uses peer education to fight the spread of HIV infection among
Indian youth who have the highest number of HIV infections (1) and lack AIDS
awareness (8, 9). A delegation of US college students was trained and sent to
India where they established local chapters in Bangalore, Mumbai and New Delhi.
They conduct personalised risk assessment and counselling, dispel misconceptions
about modes of transmission and enable behavioural modifications. The local
chapters reach out to secondary schools to disseminate knowledge on HIV/AIDS.
The message has been delivered to over 40,000 individuals. The efficacy of these
interventions have not been formally evaluated.
Ethical considerations
An international approach to responding to HIV/AIDS
must acknowledge interdependence and, while providing aid, respect individual
and national autonomy. By mobilising the community and individuals, it works
towards sustainability. Passive global funding of treatment and prevention
programmes falls short of such mobilisation. A national system of risk
assessment and prevention counselling needs to be built into the primary health
care system. Local community-based programmes that empower individuals need to
be complementary to such an integrated system of primary health care.
References
1. National AIDS Control Organization. Surveillance for HIV
infection/AIDS cases in India. Ministry of Health and Family Welfare, Government
of India, New Delhi, 2001.
2. Creese A, Floyd K, Alban A, Guinness L.
Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of
the evidence. Lancet 2002;359:1635-47.
3. Marseille E, Hofmann PB, Kahn
JG. HIV prevention before HAART in sub-Saharan Africa. Lancet
2002;359:1851-6.
4. Cohen MS. HIV and sexually transmitted diseases: the
physician's role in prevention. Postgrad Medicine 1995;98:52-8,
63-4.
5. Singh S, Fukuda H, Ingle GK, Tatara K. Knowledge, attitude, the
perceived risks of infection and sources of information about HIV/AIDS among
pregnant women in an urban population of Delhi. J Commun Dis
2002;34:23-34.
6. Baksi C M, Harper I, Raj M. A 'well woman clinic' in
Bangalore: one strategy to attempt to decrease the transmission of HIV
infection. International Journal of STD and AIDS
1998;9:418-23.
7. Solomon S, Buck J, Chaguturu SK, Ganesh AK, Kumarasamy
K. Stopping HIV before it begins: issues faced by women in India. Nature
Immunology. 2003;4:719-21.
8. Singh S. Study of the effect of
information, motivation, and behavioral skills intervention in changing AIDS
risk behavior in female university students. AIDS Care 2003;15:71-6.
9. Ganguli SK, Rekha PP, Gupte N, Charan UA. AIDS awareness among
undergraduate students, Maharashtra. Indian J Public Health. 2002;46:8-12.
PRASHANT VAISHNAVA*, ASHIR KUMARâ€
†Department Of
Pediatrics And Human Development, *†College Of Human Medicine, Michigan State
University, East Lansing, Michigan 48825 Usa. E-Mail:Vaishnav@Msu.Edu
