India has had a sharp decrease in the estimated number of HIV infections, from 2005 reports saying 5.2 million to 5.7 million had HIV to 2007 UNAids reports saying that number is now between 2 million and 3 million.This brings the HIV prevalence rate in India below many western nations including the US, Canada, Italy, France, and Spain, at .36 percent.
India's national epidemic is made up of a number of local epidemics, and in some places they occur within the same state. The epidemics vary, from states with mainly heterosexual transmission of HIV (85%), often via interaction with sex workers, to some states where intravenous drug use is the main route of transmission. Both tracking the epidemic and implementing effective programmes poses a serious challenge to the authorities and communities in India. HIV surveillance in India falls under the auspices of the National AIDS Control Organization (NACO). The majority of HIV surveillance data collected by NACO is done through annual unlinked anonymous testing of prenatal clinic (or antenatal clinics) and sexually transmitted infection clinic attendees. Annual reports of HIV surveillance are freely available on NACO's website.
India has a large population and population density, low literacy levels and consequently low levels of awareness, and HIV/AIDS is one of the most challenging public health problems ever faced by the country. A recent study published in the British medical journal "The Lancet" in (2006) reported an approximately 30% decline in HIV infections among young women aged 15 to 24 years attending prenatal clinics in selected southern states of India from 2000 to 2004 where the epidemic is thought to be concentrated. The authors cautiously attribute observed declines to increased condom use by men who visit commercial sex workers and cite several pieces of External links
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The immediate scientific and medical response to the 1984 Bhopal disaster constituted an extraordinary pulling together of hospitals, medical personnel and social services in the area. Coping with a disaster of this scale was unheard of anywhere in the world, and there was widespread admiration for those who responded, often risking their own lives in the process.
However when the long term after effects of this disaster began to appear, it was obvious that the social, political, and legal climate was inadequate since there was little experience in dealing with a major environmental release. Scientific and medical personnel needed access to accident- related and toxicologic information to understand the causes and potential consequences of the disaster. Union Carbide
, the primary repository of this information, faced with lawsuits and the prospect of bankruptcy, closed down its channels of communication. On the other hand, the extreme sensitivities of the local and national government bodies towards all aspects of the disaster, coupled with the lack of expertise and funds, resulted in an inadequate response on India\u2019s part to meet the urgent health care and social recovery needs of the community. Whereas local health professionals and the interested scientific community abroad expected a flood of information from a disaster of this magnitude, only a trickle resulted.
These transnational political and legal ramifications threw a veil of secrecy around the disaster and obstructed the discovery of vital medical and toxicologic information. The medical community was often frustrated in its attempts to understand the links between gas exposure and health and devise appropriate treatment strategies. As an example, ignorance about whether the main poison, methyl isocyanate
, could decompose to deadly cyanide gas, led to years of acrimonious debate on the merits of treating the gas victims for cyanide poisoning.
Recognizing the dire need of the gas victims, the Permanent Peoples\u2019 Tribunal met in 1992 and recommended that an international medical commission provide an in-depth independent assessment of the situation
in Bhopal. The International Medical Commission on Bhopal (IMCB) was thus constituted with 14 professionals from 12 countries who were chosen on the basis of their medical expertise and experience in environmental health, toxicology, neurology
, and respiratory medicine. Drs. Rosalie Bertell and Gianni Tognoni served as the co-chairpersons of the IMCB. At the request of Carbide gas victim organizations, the IMCB conducted a humanitarian visit to India in January 1994 to contribute in any way possible to the relief of the victims and to suggest ways to in which such catastrophic accidents could be prevented in the future or their effects mitigated. During their stay, the IMCB met with government officials, various disaster experts, hospitals, research teams, local private physicians, biochemists, botanists, various survivor groups, environmental activists and veterinarians.
4. Mobilization of international assistance in response to the request of survivors rather than waiting for government invitation.
10. Alerting the Government of India to the need for full disclosure of potential hazards and environmental impact studies prior to allowing any hazardous industry to set up in India
victims\u2019 organizations, and all other interested parties; b) stand ready to assist the government of India and medical colleagues to implement the recommendations of the commission; c) enlist the National Advisory Committee to follow up the initiatives of the commission; d) recommend research studies to be undertaken in India on the long-term effects of the gas exposure, and e) assure the wide circulation of its experience and findings in the professional literature.
The IMCB publicly condemned Union Carbide and reiterated the company\u2019s full liability not only for responsibility in causing the deadly gas leak, but also for the confounding role of its behavior with respect to pre-accident preventive and exposure mitigating efforts, and the timely and effective application of the appropriate medical measures at the time of the accident. This included the lack of transparency about the composition of the gases released, resulting in the absence of rational methods of care and planning resulting in loss of sight and in some cases life, and creation of suspicion and conflict among professionals and the population. There was also a lack of emergency preparation which would have made the public and professionals aware of the potential toxins inside the plant and how to respond to an accident.
The government of India also was faulted since no clear guidelines were laid down to determine compensation to the victims resulting in undue delays and aggravation of their health status and/or economic survival. The secrecy surrounding the health studies undertaken by the Indian Council of Medical Research may initially have been instituted to protect the litigation process, but in reality made the rational medical treatment and establishment of claims almost impossible. In hindsight, it is clear that the secrecy served no purpose whatsoever and has resulted in non- publication of the information. Moreover, because of the secrecy about the accident itself and the chemicals released, it was difficult for the survivors to document their claims. The Commission also noted an excessive fear among government personnel of bogus claims.
In fulfilling its commitment, results of the community studies conducted by the IMCB have been communicated to the affected population in the form of public meetings, which provided a forum for the victims to ask questions and provide comments. The studies have also been published in various national and international journals so that the scientific Recommendations of the IMCB
1. Reorganization of the health system to establish a network of community-based primary care clinics; 2. The gas-related disease categories need to be broadened to include central nervous system and psychological (PTD) injury; 3. A conference to determine best practice rehabilitation medicine
, including both Western and Indian expertise, must be undertaken to develop rational treatments and prescription drugs for survivors. 3. Health data collected by the ICMB should be communicated to the population and submitted for publication in professional journals. 4. Gas victims to have the right of access to their medical records; 5. Victim organizations should be adequately represented in the national and state commissions dealing with the disaster; 6. Criteria for compensation should include medical, economic and social damage to the victims 7. Allocation of resources for economic and social rehabilitation of people and their communities should be made. 8. Thorough examination of the impact of the toxic waste buried on the Union Carbide site and its potential for further damage to public health needs to be researched.
It is now well known that persistent and chronic gas-related health effects are present in the Bhopal population.   However, the full spectrum of effects is yet to be defined, especially in those exposed as children or in utero, and as manifested in survivor reproductive health.  There has been a lack of systematic collection of relevant information in these reproductive effects, and also with respect to cancer development or other chronic illnesses as sequelae of the gas exposure.
Recent investigations have shown that local well water has become contaminated by the improper storage of a large amount of hazardous waste in the facility, or on its grounds. This toxic waste is especially hazardous to those still suffering the effects of direct exposure to the gas.
As of 2007, the prospects for learning the sequelae of this disaster do not appear to be bright. What is sorely needed is an independent body to coordinate the heath care, research, rehabilitation of gas victims, and care for potential effects in their offspring. Instead of the non-directive symptomatic medical treatment that currently exists, clear guidelines and criteria need to be formulated for specific medical conditions such as damage to broncial tubes, sleep apnea, neuron destruction, etc. . Such an effort could be implemented through India's existing heath care pyramid. Community-level health units should be developed to serve a maximum of 5000 people each. Local hospitals with multiple departments can be used to provide secondary care. A specialized medical center dedicated to treatment and research of the more serious problems arising from the gas leak should be established.
The IMCB believes it is a mistake to simply increase the number of hospital beds in Bhopal. The community has need for more neighborhood clinics, non-drug respiratory therapy, clean air and water, and sheltered workshops, not for more hospital beds.
The IMCB has recommended that long-term monitoring of the community for illness and response to treatment be done for several decades. This would include the study of exposed and unexposed areas to observe patterns of illness and death as well as to detect the occurrence of related chronic diseases and the appearance of new diseases. Such an approach needs to be one in which the health professionals involve the community of gas victims as active partners in investigation, provide them with feedback on community health, ensure that their health risks are properly communicated, and thereby enabling
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