Report on psycho social issues of PLWHA in India- Kerala data

[Guest guest]

Dear Ashok,

Let me congratulate you for producing one of the best papers in HIV/AIDS

in India. I was surprised that such a high percentage of infected people

belonged to the low income group. You had pointed out that many infections

had occurred during the time the wife had gone to her people for delivery

etc. Dr.T. , the Virologist from Vellore told me that this was

one of the common times when men got infected in T'Nadu too. But this does

not happen in Kerala perhaps because wives do not spend such a long time

with their mothers or perhaps they have sex even during advanced

prregnancey. There is no taboo here on sex during pregnancy. Perhaps we

should highlight the dangers of wives staying away from husbands for too

long. I am attaching an abstract of a paper I did on the features of the

infection in Kerala. This was on a series of about 260 infected people. You

might find it interestng.

Features of the migration related HIV epidemic in Kerala, India

Issues

The HIV epidemic in the South Indian State of Kerala is distinctly related

to migration and presents unique features which differ from other neighbouring

states.

Description

Kerala has high literacy and poor industrial development, as a result of

which, there is considerable migration to other states for work. 40% of the

households have at least one migrant. 81% of outmigrants are unmarried and

the lack of urban housing forces most men to leave their families behind.

The cases reported so far were analyzed to identify the features of the

epidemic in the state. More than 95% of the infections were acquired

through heterosexual sex. The male: female ratio is 3:1. Most of the men

have been infected in cities outside the state through sex with female sex

workers. The emigrants have generally been infected in India while visiting

sex workers either before leaving or on transit. The infected men in turn

infect their wives. Unlike other Indian states, there is no higher HIV

prevalence in urban areas in Kerala. Generally skilled workers are most

commonly infected. It is uncommon to see a farm worker who is infected. The

median age for infected males is 31 years and 27 years for females. This is

related to the higher age at which people migrate and the higher age of

marriage for women which is 22.1. HIV infection is uncommon below the age

of 20 years.

The HIV prevalence among antenatal women is less than 0.2%. But this gives

a false impression regarding the state of the epidemic, since, much of the

currently infected population live outside the state. They often come back

for care and to be with the family, when they learn, that they are infected

or become symptomatic. Awareness of migrants regarding AIDS is low because

of unfamiliarity with the local language. Interventions were tried outside

the state but have not been very successful. They were also found to

stigmatize the people addressed.

Conclusions

The HIV burden of Kerala is much more than what is apparent. Interventions

among those who migrate for work should be done before they leave.

ation with other states and even work with organizations abroad is

required.

Dr.M.Pr

E-mail: mpkumar@...