HIV(seed)

SOIL AND SHOWER

OF
HIV / AIDS IN INDIA HOST ENVIRONMENT
(SOIL)) (SHOWER)
DISCUSSION FROM A DIFFERENT ANGLE
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 CONCETRATED
• EPIDEMIC EPIDEMIC
• >5% in high risk groups+ >1% (>5% IN HIGH RISK +<1%
IN PREGNANT WOMEN PREGNANT WOMEN
• MAHARSHTRA,TAMILNADU,KARNATAKA, GUJARATH,GOA,KERALA,WESTBENGAL
• ANDHRA PRADESH,MANIPUR NAGALAND

•
LOW LEVEL
REST OF INDIA
EPIDEMIC (<5% IN
vulnerable WITH HIGH
HIGH RISK+<1% IN
STD
PREGNANT WOMEN
UTTAR PRDESH,MADHYA PREVALENCE
PRADESH,BIHAR,RAJASTHAN
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

 CONFOUNDING SITUATION
AT MIZORAM
VIOLENCE POLITICAL INSTABILITY

FALSE SECURITY
FALSE COURAGE
UNEMPLOYMENT &
IDLE YOUTH
HALLUCINATIONS
DELUSIONS

DRUG ABUSE& FREELY AVAILABLE

HIV DRUGS
EPICENTRES-2&3 (SOIL &SHOWER)
MAHARASTRA, ANDHRA PRADESH, TAMILNADU,
KARANATAKA

SOIL SHOWER

UNSAFE SEX , ILLEGAL SEX

COMMERCIAL SEX WORK POVERTY,

MULTIPLE SEX PARTNERS MUMBAI,PUNE,SATARA.CHENNAI,

LESS CONDOM USE 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 BIG BUSINESS

TRUCK DIVERS •CONTRACTORS ENOLL
SEXWORKERS AND DROP
•LEAVING THEIR THEM AT DHABHAS IN THE
EVENING AND COLLECT
WIVES AT HOME THEM IN THE MORNING
THEY COLLECT
LONELINESS, COMMISSION FROM CSW.
•DHABHA OWNER IS ALSO
RESORT TO ILLICIT CHEAP BENFITED DUE TO MORE
SEX NUMBER OF CUSTOMERS
AT DHABHAS WEAK ENFORCEMENT OF
RESTRICTION OF IMMORAL
HIV TRAFFIC ACT IS ANOTHER
SEEDLING ALONG FACTOR.
HIGHWAYS
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

•CULTURAL CHANGES--

STYLES REGARDIG SEXUAL

PRACTICES
•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 GENERAL
&INJECTABLE
CLIENTS OF CSW, POPULATION
DRUG
STD PATIENTS,
USERS(IDU)
PEERS OF I.D.USERS
(HIGH RISK)
(BRIDGE)
 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 HIGH
RISK GROUPS ESPECIALLY THE YOUTH
• USE DEADDICTED PATIENT FOR MOTIVATION OF
NEW ADDICTS
• SCHOOL CURRICULAM TO INCLUDE THE ADVERSE
EFFECTS OF THE DRUG ABUSE AND CONTAMINATED NEEDLE
USE
• CONTROL DRUG TRAFFICKING ACROSS MYANMAR
BORDER
• 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 NEEDS
TACKLING AT PERSONAL LEVEL FIRST
AS IT IS A LIFE STYLE DISEASE , LIFE STYLE
MODIFICATIONS ARE ESSENTIAL
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.