25 years into AIDS epidemic: What we gained, what we lost? What'ss the future?

[Guest guest]

25 years into AIDS epidemic: What we gained, what we lost? What is the future?

The detection of first cases of AIDS completes 25 years today, after the Centres

for Disease Control, USA, published its finding on the new epidemic on 5th June,

1981. Twenty five years is indeed an opportune time to take stock of the

situation vis-Ã -vis HIV/AIDS and its medico-socio-economic impact on the human

race across the globe. There is no other disease where such a fast and quality

research is done in such a short span of time. In several diseases

even the causative organisms could not be detected for more than a century.

As regards to AIDS, we know the disease and its course, its causative organisms

and their behaviours, how it is transmitted and how it is not? Where does it

multiply and how fast? How to stop its growth? Even we know several medicines

that stop the further progression, Opportunistic infections- their course,

prevention and effective treatments, Prevention of Mother to Child Transmission,

Prevention through blood and blood products, efficacy of condoms, How and why it

is not transmitted to treating doctors and other

healthcare providers? What is not known is the perfect Vaccine to and

established vaginal microbicide to prevent its transmission, What actually

triggers its progression, mechanism behind long-term non-progressers etc.

What we gained?

Whenever any epidemic comes; we always think and talk about what we lost and its

negative impact. Rarely we talk about its positive impact and rarely we thank

the epidemic! Let us look at the vast list of our gains vis-Ã -vis HIV/AIDS

epidemic:

1. We gained sanity in this wild world, “ sanity of morality, sexuality and

sensuality. Prior to HIV/AIDS, despite the existence of several STDs, nobody

doubted somebody's sexuality, sexual preferences or STDs when sexual

advancements were made.

2. Blood safety and Blood Products safety: More than 20 Transfusion-Transmitted

Diseases are under scanner/control, nobody looked at

them till HIV arrived, despite laws to mandatory check for Syphilis and

Hepatitis-B in India since 1977, they were seldom checked till awareness about

HIV grown and till we fought the importance of blood safety

3. Barber safety: Safe Barber practices started only after HIV arrived; though

Barbers can transmit >15 infections (bacterial - Sycoses Barbae and fungal

infection - Tinea Barbae)

4. Laboratories and Hospital safety practices under Universal Precautions gained

its due importance only after HIV/AIDS arrived

5. Importance of Safe Pregnancy and preventing mother to child transmission of

infections

6. Clean needles for Injection Drug Users (IDUs)nobody ever thought this avenue

earlier

7. Popularisation of condoms its varieties, colour, flavours, textures etc.

Condom not only prevents HIV, but 22 STDs, but it was never a popular devise for

preventing STDs

8. Condom Prevents - unwanted pregnancies, one's progeny born at odd

locations,

9. Attention to Sex Workers: Sex workers were treated as persona non-grate, like

gutters in the cities whose existence is necessary but never acknowledged

(rather acknowledged only when there is water-logging). AIDS has brought the

long overdue attention to SWs

10.Life and miseries of truckers and their potential of transmitting STDs

11. Mainstreaming of the marginalised communities like Hijras, Men having sex

with men

12. STDs have been reduced by 80 to 90% in last 20 years ever since AIDS has

come

13. The number of Sex workers is sinking to all time low

14. Importance of non-penetrative sex, masturbation etc. were realized only now

15. Importance of Sex education in colleges, schools and communities and role of

youth

16. Importance of Indian Pharma companies in saving millions of lives

17. Exposed the money-minded MNCs who made 1000 to 2000% profits on their

products

18. Looking at prevention of post-marriage problems through pre-marriage

counseling and health checks rather than astrology/horoscopes.

19.Knowledge of several Opportunistic Infections and their treatment patterns

20. Exposing the indifference of medical professionals and their unethical

practices

What we lost?:

1. Millions of lives – close to 30 millions all over the world and 1-2

millions in India since 1981

2. Lost several Breadwinners – leaving behind widows and orphaned children

3. Social fabric un-woven

4. Economic impact – where communities and countries are becoming poorer and

poorer

5. Survival rate in African countries down by 10 to 30 years, the lowest being

27 and 31 years in Swaziland and Botswana

6. Gains made in reducing infant mortality and childhood mortality rates in

Africa

7. Due importance to other life threatening conditions/diseases, because of

attention to AIDS

DECREASE INCREASE

Sexually Transmitted Diseases HIV/AIDS Awareness

Unwanted pregnacies/abortions Care for AIDS Patients

Number of sex workers Responsive Behaviour

Number of clients to sex workers Condom usageFresh HIV infections

Blood Safety

Where does our future lies and what we need to do?

When our foreign reserves are over 136 billion US$ and we pre-paid the ADB

loans, do we need the World Bank loan or external aid to stop AIDS and to

control TB? Can we manage our health affairs and save millions of our people

from getting sick and dying for want of timely and proper medications?

If Gates can support 200 million US$ for Indian AIDS program, why can't our

business giants match it for our own people? This needs a serious debate. High

'political will' to contain TB & HIV is needed, beyond World TB Day and AIDS

Day, and be transgressed into realistic action plan. Let Health and AIDS issues

become part of election manifestoes.

1. Stop debating the number game andaccept gracefully that HIV is widespread in

India

2. Free/Subsidised and graduated cost treatment for PLWHA in India, with a view

that each of them needing ART have access to anti-HIV drugs

3. Moving from 'Donor-Dependence' to 'Self-reliant' National AIDS Control

Program. Make NACO an autonomous forceful body with multi-sectoral

collaboration. We must critically review foreign collaborative programs and

their liability vis-Ã -vis benefits.

4. Support to NGOs should be evaluated. There is no proper definition of NGO.

While genuine and globally acclaimed NGOs with technical expertise are

sidelined, funds are given to the likes of Krida and Yuva Mandals, political

affiliates without evaluation/audit

5. Anti-discrimination bill should be passed soon.

6. Women & Children: Reduce vulnerability of women to HIV by improving health,

legal and social status. Prevent mother to child transmission as an emergency.

7. Youth, Alcohol & AIDS: Nearly 70% HIV cases are in age group 20-35. Why HIV

continues its upward trend in India even today? The answer is simple: here HIV

Prevention and Promotion goes hand in hand.

8. Project India as a powerful and gullible poor country and market its assets

like Low cost patient management skills and low-cost high quality medicines

9. We need to work on war-footing to stop AIDS and its negative impact on

humanity

10. Collaborate with like minded people, agencies, organizations locally and

globally

_________

Padmabhushan Dr. R D Lele, who had diagnosed India's first AIDS case in1986;

Prof. K C Mohanty, Consultant in TB/Chest Medicine, Executive Chairman, PHO;

Prof. J K Manaiar, HIV/AIDS Consultant and Sr. Vice President, ASI; Dr. D G

Saple - HIV/AIDS Consultant and Treasurer, ASI and Dr. I S Gilada, HIV/AIDS

Consultant, Hon. Secretary ASI and PHO addressed the Press Conference

Dr. I S Gilada

Hon. Secretary, AIDS Society of India &

Peoples Health Organisation (India)

e-mail: <gilada@...>