India flawed by focus on sex in campaign against AIDS: study

[Guest guest]

[Moderators note: Combined posting. Gisselquist and Corea raised some

fundamental aspects of HIV response in India. The following are the abstract of

these articles from the International Journal of STD & AIDS, Volume 17, Number

11, November 2006,]

1)India flawed by focus on sex in campaign against AIDS: study

2) A passage to India's HIV epidemics: sending out an SOS

3) Routes of HIV transmission in India: assessing the reliability of

information from AIDS case surveillance

4) How much does heterosexual commercial sex contribute to India's

HIV epidemic?

5) Reconnaissance assessment of risks for HIV transmission through

health care and cosmetic services in India

____________________________

1) India flawed by focus on sex in campaign against AIDS: study

PARIS (AFP) - India is making perilous mistakes in its fight against

AIDS by assuming the human immunodeficiency virus (HIV) is being

spread overwhelmingly by sex and especially by prostitutes, a study

warns.

India is considered by many specialists to be an easy target for

AIDS, despite the health authorities' insistence that they are

making headway against the disease. In May, the Geneva-based agency

UNAIDS said India had 5.7 million people living with HIV/AIDS -- the

highest figure in the world, ahead of South Africa where the figure

stands at 5.5 million. The government says the tally is 5.2 million.

The new study, published by Britain's prestigious Royal Society of

Medicine, does not wade into the row over these figures, but instead

lashes India's assumption that sex, especially with prostitutes, is

the main driver for new infections.

" It is inconsistent with evidence and very likely wrong, " is the

blunt verdict delivered by US researchers Gisselquist and

Mariette Corea in the society's International Journal of STD and

AIDS.

According to India's National AIDS Control Organisation (NACO), 86

percent of HIV infections are from sexual transmission, and

according to three studies that have helped underpin the country's

AIDS strategies, prostitutes account for 27 percent of the total.

But Gisselquist and Corea -- who did extensive field research in

India -- say these calculations are terribly wide of the mark.

The total estimate of infections comes from hospital staff, who

assess and report routes of transmission for patients admitted with

AIDS.

But many personnel routinely assign cases to the category of sexual

acquisition without asking if the patient may have been exposed to

infection through blood, the authors say.

And they argue the official tally of prostitutes in India, their

number of clients and the frequency of clients' visits are probably

huge overestimates.

In addition, there is evidence that commercial sex workers are far

likelier to use condoms and less likely to have HIV than health

officials believe, the study says.

Its best estimate is that prostitutes account for just two percent

of HIV infections -- and a high estimate would be 13 percent, less

than half that of NACO's figure.

This means that India is ignoring threats from other sources, in

particular the re-use of unsterile instruments in hospitals,

cosmetic services, dental surgeries and tattoo parlours.

In one incident, commercial sex workers reported they had stood in

line for tattoos that were administered without changing needles or

inkpot between customers.

And the researchers found a common mistaken belief among the general

public as well as the medical profession that HIV survives no more

than seconds or a few minutes outside the body.

" The official sexualisation of the HIV epidemic has blinded just

about everybody to considering (and protecting against) non-sexual

routes of transmission, " the journal said in an editorial.

http://news./s/afp/20061026/wl_sthasia_afp/healthaidsindia_0

61026232005

_____________________________

2) A passage to India's HIV epidemics: sending out an SOS

Author: Potterat, J.1

Source: International Journal of STD & AIDS, Volume 17, Number 11,

November 2006, pp. 718-719(2)

Abstract:

The official view is that India's epidemics are driven, directly and

indirectly, by heterosexual prostitution. Review of available

evidence by researchers in India undermines this weakly supported

orthodoxy and suggests that correcting weaknesses in its AIDS

surveillance system can lead to a more reliable picture of HIV

propagation and hence to evidence-based interventions. Contenders

for leading roles in HIV transmission are under-suspected and

unmeasured skin-puncturing exposures

_____________________

3) Routes of HIV transmission in India: assessing the reliability of

information from AIDS case surveillance

Authors: Correa, Mariette1; Gisselquist, 1

Source: International Journal of STD & AIDS, Volume 17, Number 11,

November 2006, pp. 731-735(5)

Abstract:

India's AIDS case surveillance system attributes 86% of HIV

infections to sexual risks, 2.4% to injection drug use, 2.0% to

blood transfusions, 3.6% to perinatal transmission, and 6.0% to

others or not specified. To assess the reliability of this

information, we examined the process of AIDS case surveillance in

four high HIV-prevalence districts in southern India. We reviewed

forms and interviewed doctors, counsellors, officials of State AIDS

Control Societies, and a convenience sample of people living with

HIV/AIDS. Current surveillance practices are not sensitive to

parenteral exposures; forms have no space to report blood exposures

other than transfusions and injections, and counsellors often ignore

parenteral risks. The system does not distinguish high from lower

risk sexual behaviours; all cases with sexual risks are reported in

one category. We propose changes in forms and practices to improve

the reliability and usefulness of information on risks from AIDS

case reporting.

________________________

4) How much does heterosexual commercial sex contribute to India's

HIV epidemic?

Authors: Gisselquist, 1; Correa, Mariette1

Source: International Journal of STD & AIDS, Volume 17, Number 11,

November 2006, pp. 736-742(7)

Abstract:

Through a search, we identified five models of India's HIV epidemic,

all of which articulate the hypothesis that heterosexual commercial

sex drives India's HIV epidemic. All five models assume more female

sex workers (FSWs) than have been mapped (counted), and more than

can be inferred from men's sexual behaviour. With best and highest

plausible evidence-based estimates (15-20% of 300,000-700,000 FSWs

are HIV-positive; FSWs have 570 client contacts per year; clients

use condoms with 60-75% of FSW contacts; and the rate of HIV

transmission from FSWs to clients is 0.0011-0.002 per unprotected

contact), FSWs and clients account for 2-15% of HIV-infected adults,

far less than model-based estimates of 44-68%. Overestimating the

contribution of commercial sex to India's HIV epidemic misleads

prevention programmes to ignore other risks, and promotes the

stigmatizing assumption that HIV infection is a sign of immoral

behaviour.

_____________________

5) Reconnaissance assessment of risks for HIV transmission through

health care and cosmetic services in India

Authors: Correa, Mariette1; Gisselquist, 1

Source: International Journal of STD & AIDS, Volume 17, Number 11,

November 2006, pp. 743-748(6)

Abstract:

Available information shows frequent unsterile medical injections in

India, but less is known about other invasive procedures. To assess

the variety and frequency of blood exposures in health care and

cosmetic services, we interviewed people living with HIV/AIDS in

four districts with high HIV prevalence. Eighty percent reported

from 1-300 injections in the five years before testing HIV-positive.

Common lifetime exposures include dental care (31%), surgery (20%),

blood tests (100%), and tattooing (47%). Through observation and

interviews with doctors, dentists, and others, we found evidence for

common to routine re-use of unsterilized equipment for blood tests

(lancets), dental care, tattoos, and surgery.

Health-care professionals and the public are misinformed about HIV survival

outside the body and underestimate HIV transmission efficiency through blood

exposures. The challenge to implement infection control for all invasive

procedures remains undefined, while attention focuses on partial solutions,

including single use of disposable syringes.

Affiliations: 1: 29 West Governor Road, Hershey, PA 17033, USA

[Guest guest]

Dear forum

I feel validated when I read a report like this. Every time some one has told me

that this is what they have picked up from their field surveys my eyebrow has

taken a sharp turn.

Simply we do not talk straight sex in India. We live in the closet. All alleged

interviews are more the bewildering imagination of the individual being

interviewed. Without the 'masala' how can you sell a good story?

I must take off my hat to the majority of organizations that claim concerned

individuals for the HIV positive.

I visit a state run ART center to collect my ARV'S monthly. The doctor in charge

avoids me as routine. Reason: I objected to the X'mas tree he had made of the

ART center. And I have to sit out side it so the world without difficulty can

identify me as HIV positive. Isn't there an overstated policy saying it is not

correct to point out HIV positive people? Added to it, it has, I am told NACO's

blessings.

I see no alternative left, but to take the Press in one day and tear down the

hoardings, placards, red curtains etc. Today was the 5th time I visited the ART

center, my objections were registered the first time.

Where are the Oh so ever sweet people who want to help (incl NACO)? They don't

see a red herring, they prefer a red ribbon that tells the world of their great

concern for 'US'. It's nice to be seen, as the good concerned citizen working

for the unfortunate is my assumption with regards to most people working in this

area of work.

The late Indira Gandhi was close to death as a young woman when TB had no cure.

Yet no one talked about TB.

Its association with sexual behavior has plagued HIV on the other hand and so is

a taboo subject per say. India is conservative till date because we are a

developing country. The educated Indian knows a lot about HIV, but has not come

to terms with the fact that HIV is 'not' knocking on our doors, but has already

come inside.

The number of time bombs walking around is yet to hit us hard in the face. As of

date we are still squabbling over how an ART center must look?

When will we get down to some serious work?

NACO for all the good work you are being validated for lets not assume you have

it all right please.

Regards

Capt(retd) Kumar

e-mail: <kumar.captretd@...>