The Strategies of Combating HIV / AIDS

 

Anand Murti Mishra1 and Praveen Kumar Shrivastav2

1School of Studies in Anthropology and Tribal Studies Bastar University, Jagdalpur (C.G.) India

2Dept. of Community Medicine, Govt. Medical College, Jagdalpur (C.G.) India

 

ABSTRACT

The spread of AIDS has not been uniform throughout the country. The AIDS epidemic has reached the third phase, which means it is has attacked the general population. Thousand of innocent housewives and children are caught in the grip of deadly virus. This has resulted from passivity and subservience of the average Indian family and her consequent inability to negotiate safe sex. India has had a sharp increase in the estimated number of HIV infection from a few thousand in the early 1990’s to a working estimate of between 3.8- 4.6 million living with HIV / AIDS in 2002. The paper aims to understand situation and combating strategies of HIV / AIDS in India.  National AIDS Control Programme in the country was launched in 1987 and in 1992 the National AIDS Control Organization came into being. During phase-1 of the programme (1992-1998) many states were in the elementary stages of setting up the infrastructure and proper reporting of AIDS cases. Phase -2 of the programme began in 1999 with emphasis on blood safely information and education control of sexually transmitted disease and promotion of condoms.

 

Keywords: Fast-dissolving tablets, Captopril, ACE inhibitor, oral cavity, In vitro dissolution.

 

 

INTRODUCTION

AIDS, is called ‘Acquired’ because it is always caught from some one else Immune Deficiency, because the virus destroys the body’s protection mechanism that fights diseases and symptoms. And HIV is, Human Immune Deficiency Virus that causes AIDS. It lives in the body fluids of the infected person, such as semen, Vaginal secretion, blood and blood-products made from infected blood. HIV weakness and destroys the defense system of the body and because the body then has no protection, many other illness make the person sick and eventually the person dies.

 

As the virus spread, it has become increasingly apparent that it in many cases AIDS is a Social-Phenomenon. Host of psychological, social, political, economic and cultural factor comes into play again highlighting the essentially social nature of AIDS. The progressive increase in HIV infection in South-East (S.E.)Asia, it is feared, will accentuate the disproportionate impact of HIV / AIDS on the developing world.

 

There are currently 22 million people estimated (UNAIDS) to be living world wide. Three-fifth of this population lives in Africa and one fifth in Asia. According to one estimate of WHO shows that about 03. 7 million adult in S.E. Asia living with HIV, predominantly in India. But the year, 2000 it is estimated that there will be some 26 million adults living with HIV worldwide. It incapacitates and kills young and middle aged adults who are at their most productive and so far it has mainly affected skilled and managerial workers of the kind that developing countries in particular cannot afforded to lose( W.H.O.,1994)

 

Study Area:

India is a country of many distinct peoples, numerous cultures and countless ruling dynasties. It comprises an area of 443446 km2 and a population of 838583988 (1991) out of it 76.80 percent dwells in rural places.


The literacy rate is 52.11 percent (M-63.86%, F-39.43%) while sex ratio is 929. The average density of population is 267 per km2. India is a Union of States. For administrative purpose the states are divided into 412 districts, 3340 towns, 5515 development blocks and 575950 villages (1995). It is a birth place of many religion, but ‘Hinduism’ is the oldest and predominant religion. India having many communities of varying modes of life. Constitutionally the responsibility for health rests with the states. The responsibility of the Union Government lies mainly the national policy formulation and in over all co-ordination of the work of the state health ministries. Present study is basically based on the data and information collected from National AIDS Research Institute, Pune, World Health Reports Population Foundation of India, National AIDS Control Organization leading new papers etc.

 

MODE OF TRANSMISSION:

Among the HIV-sero positive groups, the sexually promiscuous constitute the largest group and next in order of magnitude is intravenous (I.V) drug users, blood donors/ recipients of blood, antenatal mothers and others which are not clearly recognized. And those who are practicing high risk behavior (HRS) are more vulnerable than others. These are-

 

(1) People with multiple sexual partners

(2) People with STD may have sores on their sex organs or discharges which makes it easier for HIV to enter

(3) People who share drug injection needles.

 

EPIDEMIOLOGICAL PERSPECTIVES:

Since the detection of HIV infection in commercial sex works (C.S.Ws) in Tamil Nadu in 1986, the infection is growing very fast in the country. As on March 1999, 85008 HIV infected persons and 7012 AIDS were reported to NACO. Although the magnitude of disease has been found to be varied in various parts of the country, the states of Maharashtra, Tamil Nadu, Andhra Pradesh, Karnataka and Manipur are hard hit states. Maharashtra accounts for close to 50% of all reported HIV and AIDS cases in India. Sentinel surveillance data collected during August-October, 1998 revealed that in the above mentioned states the infection in pregnant mothers, in high risk groups like STD clinic at tenders, C.S.Ws, injecting drug users etc. has shown galloping increases. Moreover, the estimated number of HIV infections in the country have been reported to be 3-5 million(NACO,1999).

 

HIV infection has been reported horn almost all states/UTS of the country and it is learnt that it is spreading beyond the high risk groups to the general population also. The rate and extent of spread has been fast and now HIV infection is as indigenous as any other disease in the country. Sexual route is mainly responsible of the majority of these infection except in the North-East(N.E.) states, where I.V. drug use is the primary mode of transmission. Nominally the spread of virus is determined by a multiple of factors.

 

(1)           Extent of prevalence of risk behaviors.

(2)           Socio economic conditions and socio cultural factors, the HIV epidemic in India has taken a varied course in different regions.

 

The cocoon that the middle class has woven around itself in the belief that only lower income people, truck drivers and prostitutes are exposed of the HIV is about to be shattered. Reports from hospitals indicate that an increasing number of people from higher income groups are testing HIV positive, it is very serious matter once HIV starts percolating down to the non high risk groups, it is a matter of great concern (N.A.C.O.). Actual infected cases are not known, because the stigma attached to AIDS forces, well to do persons normally visit to private doctors.

 

Our culture is still unhinged in its tradition of high morality, monogamous, marriage system and safe sexual behavior. Majority of our younger generations and youth still practice virginity till their nuptial day. The religious customs and god fearing living habits are shield of protection against many social evils. It will be difficult even for the HIV to penetrate this shield except in certain metropolitan populations. But the real danger lies in another direction. Though we claim superiority in our meta physical sphere. A good share of our urban population is actually made up of floating rural population reaching the cities and industrials town in search of studies or employment and is normally not lives with families. These large groups when return back to their home they are the potential carriers of HIV. So the idea that AIDS is confined only to cities will soon become a myth. Major challenge in the context of AIDS is their intimate association with the issue of sexually which continue to be taboo in our society and not discussed openly. It has complicated the process of finding viable solutions to the problem.

               

Above analysis indicate that HIV epidemic is spreading fast not only geographically but also increasing numerically among different risk groups, mainly through the sexual route. The evolution of the epidemic in various parts of India is also not uniform. Many states/UTs have reported HIV prevalence mainly confined to high risk groups, but there is possibility for transmission of infection to general population. While in the main cities of some states such as Maharashtra, Manipur and Tamil Nadu, the epidemic is already in its advanced phase, while in other states the problem is only in early stage.

 

MAJOR RISK GROUPS:

In India, an expert of AIDS says that main route of HIV in various general families is through prostitutes and truck drivers. In modern Indian society, the youth have comparatively less moral character and some of them are ready to cross the moral limits, and it is very serious matter which makes the way easy to spread the HIV in advanced families of the Indian society. The maximum cases of AIDS are reported due to unprotected sex in the age group of 15-40 years, because this is the main age of sexual activity.

               

Another important way of HIV transmission is through migrant workers to their unsuspecting wives in their native places. The highest risk activity Indian women can do today is to have sex with her own husband because nearly 90 percent of HIV positive women have been normally infected by their own husband. Reports from NACO say that the percentage of HIV positive blood samples from ‘ante-natal’ mothers has gone up. According to I.C.M.R. the HIV positive figure has increased in recent years and women are the center of HIV epidemic. Available data show that HIV infection rates among female sex workers are rising steeply in many cities of India and situation may further worsen if the interventions are not effective. Because of sexual, economic and biological vulnerability of women to HIV / AIDS and the gender bias prevalent in the society, women are at risk for HIV infection, if they have multiple partners, but women are also at risk for HIV from coercive sex, from their economic status which force them into selling sex for money or other favors.

 

FAVORABLE FACTORS:

(1)   Male-female ratio in the population of our country is one of the important factor, as extremes in the sex ratio, have been associated with an increase in promiscuity which leads HIV / AIDS.

(2)   Patterns of marriage and divorce are also one of the main determinants of HIV / AIDS infection. The incidence has been reported higher among single divorced or separated people in comparison to married people.

(3)   Urbanization and other social factors like life style, social disruptions caused by disasters wars and civil unrest, influence of culture on sexual attitude and behavior, greater permissiveness, co-education etc. are also important predisposing factors. Prostitution is still a major factors in the transmission of HIV.

(4)   Pattern of sexual behavior including attitude towards premarital and I extra marital sex, female chastity before marriage and female fidelity with in; marriage, are also important determinants.

 

NATIONAL AIDS CONTROL PROGRAM:

The National AIDS Control Program was launched in India in 1987. In 1992, Government of India negotiated an IDA credit of U$$ 84 million to support the implementation of a 5 year HIV / AIDS Control Project from September 1992 to September 1997. The project was later extended up to 31st March, 1999. The objectives of the project were:

 

1.     To show the spread of HIV.

2.     To decrease morbidity and mortality associated with HIV infection.

3.     To minimize socio economic impact resulting from HIV infection.

 

A National AIDS Control Organization was set up with a Project Director in the rank of Additional Secretary to Government of India and supporting technical and administrative staff. A National AIDS Control Board was set up under the chairmanship of Secretary(Health) to review policies, expedite sanction, approve purchase of equipment and award contracts to private agencies. The National AIDS Committee was constituted under the Chairmanship of Minister of Health and Family welfare for effective intersect oral coordination in implementing the program. State AIDS cells were established in the 25 states and 7 unions territories with technical and administrative powers for implementing the scheme.

 

ACHIEVEMENTS OF THE NATIONAL AIDS CONTROL PROGRAM IN INDIA:

Centers spread through out the country. A sentinel surveillance system was introduces to monitor the trend of the infection with 55 sentinel sites which were increased to 180 in 1998.

·         Control of sexually transmitted diseases by strengthening and establishing 504 STD clinics and 5 regional STD research training centers.

·         Establishment of National and State Blood Transfusion Councils to oversee the progress made in blood safety program. 815 blood banks at various levels have been modernized and 40 blood component separation units established. Complete ban on professional blood donations w.e.f. 1st January 1998 and mandatory screening of blood units for HIV, Hepatitis B, Syphilis and Malaria.

·         Scaling up of awareness and social mobilization by using mass media, advocacy and involving NGOs / CBOs. Sensitizing University students through University talk AIDS program.

·         Successful implementation of targeted intervention projects for high risk population like commercial sex workers, truckers and injecting drug users etc.

 

NATIONAL AIDS CONTROL PROGRAM PHASE II (NACP-2):

The 2nd National AIDS Control Program (AIDS 2 Project) will shift focus from raising awareness to changing behavior through interventions, particularly for groups at high risk of contracting HIV. The project would support decentralization of service delivery to the states and municipalities and a new facilitating role for NACO. The project will help to protect human rights by encouraging voluntary counseling and testing and discourage mandatory testing. The project would support structured and evidence based annual reviews and ongoing operational research. The project would encourage management reforms to bring about ‘ownership’ of the program among the states, municipal corporations and other implementing agencies. NACP 2 has two key objectives namely, 

 

(1)           To reduce the spread of HIV infection in India.

(2)           Strengthen India’s capacity to respond to HIV / AIDS on a long term basis. Govt. of India also realize that the efforts made in the direction of containment of the epidemic will be successfully only when ready support and active participation of the community in combating HIV is ensured. To involve the different section of the society, the government have taken measures which are in various stages of implementation.

 

EDUCATIONAL AWARENESS:

It is desirable to raise the preventive awareness in the issue of sexuality with the deep cultural silence that regions over the subject difficulties lay in tackling, dual cultural standards which enforce strict sexual propriety on the outside. It is also essential to introduce AIDS education at higher secondary and graduate level with the advise of the parents, because it is a issue of cultural sensitivity, AIDS health education is the process of using information communication motivation to change the behavior of people to adopt healthy practices and life styles, advocate social change, needed to control the spread HIV. It is also desirable and recommended that information and educational activities are being intensified with the as follows objectives.

 

1.     Creating awareness among people and high risk groups, about the spread of HIV.

2.     To promote the concept and practice of primary protection among high risk groups.

3.     Awareness about local epidemiology.

 

PRECAUTION:

It is very essential that every one should take two main precautions to protect themselves are, so practice safe sex that is by staying in a mutually faithful relationship with an uninfected partner or by using condoms. And infected women should avoid pregnancy. Most important is the younger generation which will have to live for a longer period and have the threat of AIDS. So it is very necessary to educate them about safe life style, which will protect them from infection. Maximum efforts should be taken to prevent HIV infection from major risk group i.e. prostitutes. AIDS education is the most important tool in this strategy. The goal has to be prevention of HIV infection to them and consequently to their customers.

 

REFERENCES

1.     Howe, G. Melvyan: A World Geography of Human Diseases, Academic Press 11 NC London. (1997)

2.     NACO HIV Testing Manual(1999)

3.     Population Foundation of India :                HIV / AIDS in India Nov. 2003, New Delhi.

4.     WHO: Health Care in S.E. Asia, World Health Organization, World Health House, New Delhi. (1995)

5.     WHO: The World Health Report, World Health Organization, Geneva. (1994)       

 

 

Received on 22.07.2009

Accepted on 30.07.2009   

© A &V Publication all right reserved

Research J.  Science and Tech.  1(1): July-Aug. 2009: 04-07