| Debates |
| Sex workers demand a voice at international forums At the recently concluded international AIDS conference in Mexico, at the UN High Level Meeting before that, and in other such forums, organisations of sex workers have demanded that they have a greater say in AIDS policy formation Read more |
| Dangerous distortions? UNAIDS's Redefining AIDS in Asia: Crafting an Effective Response, a comprehensive review of the realities and impact of AIDS in Asia, misses some vital causes of the spread of the epidemic such as unsafe practices in public health services and makes some faulty assumptions about Asia’s HIV epidemics, say Mariette Correa and David Gisselquist Read more |
| The miseducation of the Indian client An international study that sought to profile men who buy sex found that of all the countries, Indian clients’ responses stood out for their low level of knowledge of sexual health issues and resistance to condom use Read more |
| Does AIDS divert attention from other public health priorities? An article published in the British Medical Journal questioned whether HIV/AIDS was an exceptional disease requiring billions of dollars in international aid annually, and argued for strengthening public healthcare systems of affected countries instead. It has caused a storm of protest from those working in the field of HIV/AIDS Read more |
Male circumcision: a cut above? |
| 20 million or 2 million? In 2006, UNAIDS declared that India had 5.7 million HIV-positive people. NACO put the figure at 5.2 million. Simultaneously, others warn that by 2010 India will have 20 million positive people. Finally NFHS-3 comes along and puts the HIV burden at 2.5 million. Where do these multiple, conflicting estimates of HIV burden come from? Who has an interest in inflating -- or downplaying -- AIDS figures? What are the different methodologies used to arrive at these numbers? Read more |
| Is HIV/AIDS skewing the priorities of the public health system? The bulk of health problems facing Indian people are simple -- malnutrition, malaria, diarrhoeal diseases, etc – and they require simple solutions -- food, mosquito control and clean water. But the government’s approach to public health increasingly focuses on vertical programmes to tackle each disease instead of comprehensive healthcare. The AIDS control programme is another vertical programme that reinforces our misplaced priorities, and also puts more pressure on an already crumbling public health infrastructure Read more |
| Why do less than half of those who require ART get treatment? Despite the fact that India is a major producer of cheap generic HIV and AIDS drugs, India’s ART programme is poorly conceived, implemented and monitored, with a shortage of drugs, equipment and personnel in most states. An unprepared public health system with no transparency is in no position to handle such an intensive programme Read more |
| Transmission: Is it just about sex and drugs? Do we really know what the various forces driving India’s epidemic are? Some studies report that around 23% of medical injections could be using unsterile syringes or needles. WHO estimated that unsterile medical injections accounted for 24% of HIV transmission in India in 2000. But India has focused almost exclusively on the sexual route of transmission. Very little space is left for non-sexual routes of transmission. This has important implications for the prevention programme Read more |
| Criminalising high-risk groups such as MSM All three core groups affected and infected in the HIV epidemic -- men having sex with men, sex workers and injecting drug users -- are criminalised in India. How can any intervention work amongst groups whose behaviour is criminalised? Basic structural changes are called for, including the deletion, or at least reading down, of Section 377 of the Indian Penal Code on sodomy, decriminalising sex work and curbing narcotics trafficking instead of punishing end-users Read more |
| Sex workers continue to be treated as vectors of disease Female sex workers constitute less than 1% of the infected female population in India. Yet, they are seen as a high-risk group and are the target of various HIV-related interventions. Such targeted interventions only end up further alienating communities instead of empowering them to combat HIV Read more |
| Moving beyond detoxification The prevalence of HIV amongst injecting drug users in India could be more than 5%. But the only government intervention for these hidden, marginalised people is detoxification. Those who cannot obtain treatment and continue to inject drugs, or those who relapse, need other methods for reducing the risk of HIV transmission, including community outreach, the provision of new needles and syringes, condom provision and drug substitution therapy Read more |
| Why are AIDS drugs unaffordable in India? The big question facing HIV-positive people in India is access to affordable antiretroviral drugs. Already, second-line drugs cost over Rs 1 lakh per person per year in India, compared to approximately Rs 50,000 in 66 other developing countries Read more |
| Prevention of HIV transmission: Do we know what works and what doesn’t? We know that HIV prevalence has stabilised or dropped in some parts of the country and amongst certain groups of the population. We know, for instance, that prevalence amongst female sex workers in Maharashtra has dropped from over 54% to 23%. And that prevalence in the general population in Tamil Nadu has dropped from 1% to .5%. But do we know why? An analysis of prevention efforts in India, the successes and failures, throws up more questions than answers Read more |
| Falling through the cracks: PPTCT in India Parent to child transmission of HIV in India infects 56,700 children every year. The third phase of the National AIDS Control Programme aims to reach 7.5 million women and give prophylactic treatment to 75,600 infected mother-baby pairs. The task is ambitious: in 2005, just 2.9 million women were reached, though the target was 6.9 million Read more |
| Do we need a separate law on HIV/AIDS? Stigma and discrimination lead to the most significant human rights violations for persons living with HIV/AIDS and are the greatest barriers to preventing further infection and providing care, support and treatment. But India has no existing legislation which would cover discrimination on the grounds of HIV. And the framework of public health legislation is too limited to adequately cover HIV issues Read more |
| Is premarital HIV testing feasible – or desirable? Three states are considering legislation on compulsory HIV testing before registration of marriage. Public health activists, however, point out that premarital counselling and life skills education, not compulsory testing, are more likely to ensure behavioural change. Such a law might end up increasing the social ostracisation of the HIV-positive, adversely affecting women, the very group the law sets out to protect Read more |
| Are we ready for provider-initiated HIV testing? At present, testing for HIV can only be done at the client’s request and with his/her consent. Recently, the WHO issued guidelines enabling a shift from client-initiated testing to HIV testing recommended by healthcare providers in any situation where they find it necessary. Does this make sense in India, which does not have the resources to test millions, and where care and treatment is not available even to the existing HIV-positive population? Read more |
| HIV and breastfeeding In many countries HIV- positive women are told to prevent transmission of the virus to their newborn child by giving them food other than breast milk. But in India, infants denied breast milk may be at risk of malnutrition as well as serious food borne infections. Jayashree A Mondkar discusses the risks and benefits of breastfeeding Read more |
| Blood safety and informing donors of their HIV status In order to provide safe blood for donation, blood banks must test each unit for HIV as well as a number of other infections. Since banks thus obtain information on a donor’s HIV status, should this information be given to the donor? Read more |
| Pros and cons of the PPTCT programme The programme to prevent mother to child transmission of HIV is supposed to reduce the chances of perinatal transmission by giving HIV positive pregnant women a short course of an antiretroviral drug. Mariette Correa points out limitations in the programme and also raises some ethical issues Read more |
| Female condoms: Shifting the burden of safe sex to women? Hindustan Latex is all set to market the female condom, particularly to sex workers. NACO is partnering with 61 NGOs across six states to reach out to 60,000 female sex workers. Sex workers in Hyderabad, where the condom was tested, say it gives them a sense of control over their bodies Read more |
| Missing the wood for the trees Following the NFHS survey, the HIV numbers game has begun again. The point is that regardless of the actual number of people infected in India, there can be no complacency or drop in political and societal commitment towards HIV intervention and the rights of positive people Read more |
| 4 lakh AIDS deaths in India: 'It is pure mathematics' Denis Broun, country representative of UNAIDS, defends a recently-published report by his organisation that states that over 4 lakh AIDS-related deaths occurred in India in 2005 -- the highest in the world Read more |