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Hard questions about HIV/AIDS

Though HIV/AIDS has generated more attention than any other healthcare issue in India, we’re still struggling with many basic questions. For example, do we really know the relative importance of the different means of HIV transmission? Does the focus on sexual transmission and injecting drug use shift the responsibility of prevention to individuals rather than the system? How can a prevention programme work if it is targeted at people involved in practices that are seen as illegal? Sandhya Srinivasan gives some answers


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. And, finally, NFHS-3 put the HIV burden at 2.5 million. M Prasanna Kumar demystifies the numbers game


Is HIV/AIDS skewing the priorities of the public health system?

By T K Rajalakshmi

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


What has changed for people living with HIV?

Many experts feel that it’s time we moved beyond HIV/AIDS awareness campaigns and began seriously tackling the practical considerations of getting medicines to patients. Awareness is important, but it’s useless if we cannot provide the medicines, they tell Ranjita Biswas


Zarina: 'We need more than information'

By Manjima Bhattacharjya

Zarina is just one of thousands of HIV-positive people caught between a government that cannot provide care and treatment to all, a private sector that is expensive and swarming with quacks, and NGOs that are driven by their own agendas


Vaccine development: Still a shot in the dark

Despite many ongoing trials, a vaccine for HIV is still a distant goal, Dr Shahid Jameel of the International Centre for Genetic Engineering and Biotechnology tells Sandhya Srinivasan


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. Such an unprepared public health system is in no position to handle such an intensive programme, say Sandhya Srinivasan and T K Rajalakshmi


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? Ashok Row Kavi calls for basic structural changes, 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


Transmission: Is it just about sex and drugs?

By Mariette Correa

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


Moving beyond detoxification

By Eldred Tellis

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



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