Hiv / Aids In India A Review

HIV/AIDS – India   An overview

      

AIDS considered as the modern pandemic of the world and    With more than 5 million people estimated to be living with HIV/AIDS, India’s HIV/AIDS prevalence is second in the world only to South Africa.

  

The Government of India estimates that in 2006, about 2.45 million Indians were living with HIV (1.75 – 3.15 million) with an adult prevalence rate of 0.41%. India’s highly heterogeneous epidemic is largely concentrated in six states – in the industrialized south and west, and in the north-eastern tip. On average, HIV prevalence in those states is 4-5 times higher than in the other Indian states. HIV  prevalence is highest in the Mumbai-Karnataka corridor, the Nagpur area of Maharashtra, the Nammakkal district of Tamil Nadu, coastal Andhra Pradesh, and parts of Manipur and Nagaland.  " We must remember that India has nearly 3 million people living with HIV. These are people facing stigma, discrimination and irrational prejudice everyday of their lives and need all our support and understanding." Hon Min.of Health Shree A.Ramodass

  

Incidence:-     According to UNICEF, 30,000 babies are born HIV positive each year in India. According to the NFHS 3 survey data in 2006 estimated population of HIV are 2.1 to 3.1 million people but its reliability some critics are questioning and claiming 5.1 to 5.3 millions. These are only estimates and there is no true cases reflecting data available.

  

SOME FACTS:-

In 1986 first case of HIV in FSW in Chennai,

In 1986 First report of  AIDS in Mumbai

IN 1991 NACP was Launched

In 2000-01 PMTCT feasibility studies initiated by NACO

In 2001 ART drugs are manufactured at considerable price reduction .

Prevalance:-

The HIV prevalence is greater among the males(0.43) than among  the females (0.29). For every 100 people living with HIV/AIDS (PLHAs), 61 are men and 39 women (taking into account the fact that the total number of men is greater than to 0.30 percent women as elucidated by the sex ratio). Prevalence is also high in the 15-49 age group (88.7 percent of all infections), indicating that AIDS still threatens the cream of society, those in the prime of their working life. Between 2005 and 2006, prevalence has fallen in some major states – Maharashtra from 0.80 to 0.74 percent, in Tamil Nadu from 0.47 to 0.39 percent – for instance. Yet, new areas of concern have emerged. In West Bengal, prevalence has gone up from 0.21 and in Rajasthan from 0.12 to 0.17 percent. And the HIV adult prevalence is more in the urban (0.4) compared to rural (0.3) ( Source: NFHS 3 India VOLUME 1,WHO/UNAIDS)

The prevalence rate is high in illiterate when compared to literate ANC and also the prevalence rate is more in ANC with spouse in driving occupation. (Source: NACO sentinel Surveillance for HIV estimation 2006)

  

 

 

While adult HIV prevalence among the general population is 0.36 percent, high-risk groups, inevitably, show higher numbers. Among Injecting Drug Users (IDUs), it is as high as 6.92 percent, while it is 6.41 percent and 4.9 percent among Men who have Sex with Men (MSM) and Female Sex Workers (FSWs), respectively.

  

People living with HIV/AIDS (PLHA):-

  

The total; No of people living with HIV/AIDS in the country estimated 2.47 million . the highest no. of PLHA are in Andhra Pradesh and in Maharastra   and with Tamil nadu and Karnataka contributes 63% of all the PLHA in the country.

  

Trends in HIV Epidemic:-

  

The prevalence rate in adults is decreasing from 0.45 to 0.36 % and also there is considerable decrease in   total PLHA from 2.73 to 2.47 millions , But in female LHAs  its almost around o.99%.

  

Projections:-

  

o 30 million HIV by 2010: Dr Soloman (March 30 2004, talk in California) 12 million HIV by 2015 according to UN (Economist, April 15, 2004) 9 million HIV by 2010 according to NACO (Economist, April 15, 2004)

  

  

  

Some Specific Characters of the disease:-

  

Caused by a RNA virus ,Man is the only reservoir in the form of cases and sub clinical cases, and got a very long incubation period  making the disease surveillance a big problem.

  

Interventions:-

  

National AIDS Control Programme was launched in 1987. Since then, the National HIV Programme has moved through three phases.   1986-1992, Denial of the Threat of HIV: This was a period that saw the beginning of a largely research-based programme. Surveillance activities were launched in 55 cities in three states.   1992-97, First Acceleration of the Programme: Backed by World Bank funding and strong WHO GPA (Global Programme on AIDS) support, this phase saw the creation of the National AIDS Control Organization (NACO).

  

1998-2001, Focus on Targeted Intervention: Building on the experience of the first phase, there was a twin drive to focus on coverage among high risk groups like sex workers, truck drivers and injecting drug users. Make the programme  multisectoral.   It has resulted in a strongly decentralized programme with the responsibility of implementation vested with the states. Flexible State

AIDS Societies were formed with stronger mechanisms for state level programme management.

  An innovative approach for providing technical support by establishing a network of 12 Technical Resource Groups (TRGs), covering different thematic areas of the epidemic and mandated to provide technical support to states.   These include building capacities to implement the strategies of prevention and building a genuinely multi – scrotal response that is sustainable.   It also involves mobilizing and coordinating a considerable range of partners, including the private sector.

           

Data Reliability???

Only estimates are there and  real cases estimation which may be due to sub clinical state and very long incubation period .

Private sector data is not available ,

Sub clinical case burden cannot be measured as they are symptom less

  

"In 2021, undoubtedly, there will still be an AIDS  epidemic ..The next 20 years  can be  different, but only if we act now"  (Robert and Jeffrey, N Engl J Med, 2001)

  

Dr.V.Sudhakaram