Re: Asia will not be able to find its way forward if it uses the wrong M.A.P

[Guest guest]

Dear colleagues,

When people think or talk about an epidemic, there is something visible and

striking. A large number of people suddenly getting hospitalised with

typhoid fever, or a number of people developing cholera with some deaths or

a dramatic increase in dengue hemorrhagic fever or Japanese encephalitis.

HIV infection is silent, no matter how many get infected. So it is

misleading to use the same word epidemic for HIV infection because people

will soon believe that it was a false alarm. Even AIDS (I prefer to call the

illness HIV disease rather than AIDS) is not an epidemic in the usual sense

as it has no sudden increase and a decline in real time -- as in all other

epidemics. Technically the term epidemic is accurate, but the peak may be

reached in decades rather than in weeks or months as in acute disease

epidemics, nor will the decline be rapid and visible as in common epidemics

in which the susceptibles are exhausted within a short period, weeks or

months.

" Explosive outbreak or epidemic " is totally inappropriate since the epidemic

is slowly progressing and not explosive.

Unless we have good disease surveillance system and HIV disease gets

reported, all estimates of infection burden or illness prevalence will

remain mere estimates with no accuracy. Most Asian countries do not have

such a system, but Thailand has a reasonable one and Singapore has a good

one. But I do not know if HIV diseases is on the reporting list.

The Indian system of " surveillance " (again misnomer, just surveys) or the

current " sentinel surveillance " (again mere sentinel surveys) cannot give

any incidence or prevalence figures with a reasonable degree of confidence.

When Tuberculosis appeared in the old world, apparently a similar phenomenon

occurred and it took some several hundred years for its epidemiology to

settle into an endemic pattern that we see today. In the beginning the

disease was more severe and with very high mortality rates. The same is the

likely trajectory of HIV/HIV disease.

Still, some understanding of the magnitude is necessary in every country. In

India the official figures put the total number infected at about 4 million.

The error may be so huge that it may range to above 10 million, but how can

any one prove it?

T .

E-mail: <tjjohn@...>

_______________________________

[Guest guest]

I think the best way to gather data on incidence and prevalence rates of

HIV disease (as opposed to AIDS) is dependent on many factors.

Stigma and discrimination are horrible in India from all the reports I get.

So maintaining confidentiality and anonymity are critical. How can that be

achieved and still get good epi data?

The best solution--which may be technically challenging in some aspects--is

a unique identifier system. If such a system can be put in place and run

effectively in India, it could be a great stride forward for all nations

facing the HIV pandemic.

What are other thoughts on the feasibility of such an approach?

M.

E-mail: <gmc0@...>

___________________________

[Guest guest]

Dear ,

The HIV drama is at the individual and family level. And our health care

system is not geared to provide support at such levels.

If the response of the government will change according to the prevalence

rate or the numbers of people already infected, there is merit in trying to

get reasonably believable figures. That is not the case in India. Numbers

are just played as arguments at various occasions.

If a nation does not know how to control dysentery and typhoid fever, how

can you expect such a nation to respond adequately to HIV and HIV diseas?

So, I am now devoting my time to build the foundations of Public Health that

we failed to lay. Kerala State will be the field. In less than five years we

will have a model replicable in each State in India. Not yet for HIV but for

communicable diseases in general, as foundation for facing any health issue

at community level.

E-mail: <tjjohn@...>

_________________________________