SOIL AND SHOWER OF HIV / AIDS IN INDIA
Transcription
SOIL AND SHOWER OF HIV / AIDS IN INDIA
SOIL AND SHOWER HIV(seed) OF HIV / AIDS IN INDIA DISCUSSION FROM A DIFFERENT ANGLE HOST (SOIL)) ENVIRONMENT (SHOWER) Dr. A.K.AVASARALA, MD PROFESSOR & HEAD DEPARTMENT OF COMMUNTIY MEDICINE AND EPIDEMIOLOGY PRATHIMA INSTIUTE OF MEDICAL SCIENCES, NAGUNUR, KARIMNAGAR ( A.P.), INDIA – 505417. E_mail : [email protected] HIV INFECTION NO DOUBT IT INVADED SETTLED SPREADING IN INDIA UNAIDS FACT SHEET 2003 HETEROSEXUALS ( SEX WORKERS )-60-70% ANTENATAL WOMEN - 1 % HOMOSEXUALS – 27 % ( NACO, INDIA) HIV/AIDS IN INDIA HETEROGENEOUS DISTRIBUTION • GENRALIZED • EPIDEMIC • • • >5% in high risk groups+ >1% IN PREGNANT WOMEN MAHARSHTRA,TAMILNADU,KARNATAKA, ANDHRA PRADESH,MANIPUR CONCETRATED EPIDEMIC (>5% IN HIGH RISK +<1% PREGNANT WOMEN GUJARATH,GOA,KERALA,WESTBENGAL NAGALAND • LOW LEVEL EPIDEMIC (<5% IN HIGH RISK+<1% IN PREGNANT WOMEN UTTAR PRDESH,MADHYA PRADESH,BIHAR,RAJASTHAN REST OF INDIA vulnerable WITH HIGH STD PREVALENCE HIV/AIDS IN INDIA • HR > 5 , PW > 1% MAHARASHTRA,TAMILNA DU,KARNATAKA,ANDHRA PRADESH,MANIPUR • HR > 5% , PW < 1% GUJARATH, GOA, WESTBENGAL, NAGALAND • HR < 5% , PW < 1% UTTARPRADESH,MADHYA PRADESH,BIHAR, RAJASTHAN SENTINEL SURVEILLANCE DATA IN METROPOLITAN CITIES RURAL SITUATION ALSO NOT SATISFACTORY MORE HIV SEEN DUE TO POOR LITERACY & UNAWARNESS AND LESS CONDOM USE 3 EPICENTRES 1. MEGHALYA, MANIPUR & MIZORAM 2. MAHARASTRA 3. ANDHRA PRADESH & KARANATAKA, AND TAMILNADU EPICENTRE -1 (SOIL &SHOWER) MEGHALAYA, MANIPUR AND MIZORAM FERTILE SOIL(SUSCEPTIBLE HOST) POOR AND UNEMPLOYED YOUNG AND IMMATURE, ANTISOCIAL TEMPTED TO INJECTABLE DRUG ABUSE CALLOUS , HENCE CONTAMINATION OF NEEDLES SHOWER (FAVOURABLE ENVIRONMENT) FREE AVALIBILITY OF NARCOTIC DRUGS DUE TO DRUG TRAFFICKING ACROSS THE MYANMAR BORDER and POLITICAL INSTABILITY favors HIV INFECTION ? CAN FREE SUPPLY OF STERILE NEEDLES SOLVE THIS PROBLEM ? IS IT ETHICAL? CONFOUNDING SITUATION AT MIZORAM VIOLENCE POLITICAL INSTABILITY FALSE SECURITY FALSE COURAGE UNEMPLOYMENT & IDLE YOUTH HALLUCINATIONS DELUSIONS DRUG ABUSE& HIV FREELY AVAILABLE DRUGS EPICENTRES-2&3 (SOIL &SHOWER) MAHARASTRA, ANDHRA PRADESH, TAMILNADU, KARANATAKA SOIL UNSAFE SEX , ILLEGAL SEX COMMERCIAL SEX WORK MULTIPLE SEX PARTNERS LESS CONDOM USE SHOWER POVERTY, MUMBAI,PUNE,SATARA.CHENNAI, VIJAYAWADA(AP) HUNGER, ILLITERACY, WITH THEIR GROWING URBAN SLUMS AND MOBILE POPULATION, CARELESSNESS, SEXUAL PERVERSIONS COMMERCIAL SEX WORK(CSW) LACK OF BROTHEL LICENCING, LACK OF MEDICAL EXAM FOR CSW EPICENTRES 2&3 DHABHAS (WAYSIDE FEEDING CENTRES OF ILLFAME) OTHER SIDE OF THE COIN •LONG DISTANCE TRUCK DIVERS •LEAVING THEIR WIVES AT HOME LONELINESS, RESORT TO ILLICIT CHEAP SEX AT DHABHAS HIV SEEDLING ALONG HIGHWAYS BIG BUSINESS •CONTRACTORS ENOLL SEXWORKERS AND DROP THEM AT DHABHAS IN THE EVENING AND COLLECT THEM IN THE MORNING THEY COLLECT COMMISSION FROM CSW. •DHABHA OWNER IS ALSO BENFITED DUE TO MORE NUMBER OF CUSTOMERS WEAK ENFORCEMENT OF RESTRICTION OF IMMORAL TRAFFIC ACT IS ANOTHER FACTOR. WHY HIV INVADED&SETTLED INDIA INDIAN SOCIETY CHANGED IN FAVOUR OF - HIV 5 HIV / AIDS IN INDIA IS NOT JUST DUE TO HIV ALONE (THE SEED) SOCIETAL CHANGE (SHOWER) •ACCULTURATION EFFECTS INCREASE IN -VE LIFE STYLES REGARDIG SEXUAL PRACTICES •CULTURAL CHANGES-- •DETERIORATED HUMAN VALUES •SEXUAL PERVERSIONS AND STD ON THE RISE •COSMOPOLITAN NATURE OF CITIES ENCOURAGING -VE LIFESTYLES •URBAN SLUMS & NIGHT CLUBS -MORE OPPORTUNITIES FOR ILLEGAL AND UNSAFE SEX •INCREASING MOBILE POPULATION AT BUSSINESS CENTRES AND CITIES FAVOURING THE SPREAD •COMPLACENCY ABOUT UNIVERSAL PRECAUTIONS &SEXUALLY TRANSMITTED DISEASES DETERIORATION MONOGAMY AT THREAT HUMAN VALUES &VIRTUES AT LOW LEVEL CELIBECY NOT PRACTICED INCREASING SEX ABUSE ESPECIALLY IN COSMOPOLITAN CITIES DUE TO • FREE AVAILABILITY OF SEX • COMMERCIAL SEX WORK AND SEX MARKETTING • NIGHT CLUBS AND CALL GIRL SYSTEM • ILLEGAL SEX • MULTIPLE PARTNERS SEXUAL • PERVERSIONS HIV IS A MAJOR BEHAVIORAL PROBLEM • HOMOSEXUALITY -- INCREASE IN • THE LONELY • ORAL SEX • ANAL SEX- CHILD ABUSE CONTROL ASPECTS SPREAD OF HIV CSW &INJECTABLE DRUG USERS(IDU) (HIGH RISK) GENERAL CLIENTS OF CSW, STD PATIENTS, PEERS OF I.D.USERS (BRIDGE) POPULATION HIV (THE SEED) WHY HIV IS PREFERRING T4 CELLS ONLY NOT OTHER CELLS WHAT IN T4 CELLS THAT IS ATTRACTING HIV ? CAN THAT SOMETHING CAN BE ELIMINATED OR NEUTRALIZED ? LIFE STYLE MODIFICATIONS-TOP PRIORITY “ MEND THE MIND MUST BE THE RULE AS HIV IS MAINLY A BEHAVIORAL DISORDER LIFE STYLE MODIFICATIONS ARE NOT GIVEN ENOUGH STRESS AT PRESENT ETHICAL VALUE OF SAFE SEX NOT MUCH EMPHASIZED CHARACTER-BUILDING NOT ATTEMPTED NO STRESS TO CURB DON’TS (-VE LIFE STYLES ) LIFE STYLE MODIFICATIONS ONLY THE CHANGE OF BEHAVIOR CAN SOLVE THE HIV PROBLEM PERMANANTLY IT IS NEITHER ADVISABLE NOR ETHICAL TO PROVIDE STERILE SYRINGES FREELY TO A DRUG ADDICT AND ASK HIM TO CONTINUE TO TAKE DRUGS NOR TO PROVIDE A CONDOM AND ASK TO VISIT A BROTHEL, BECAUSE IN BOTH THE STRATEGIES, BEHAVIOR AL CHANGE TO CURB RISKY BEHAVIOR WILL NOT OCCUR BUT WILL CONTINUE. . MIZORAM HIV CONTROL • CONFOUNDING SITUATION • BRINGOUT THE BEHAVIORAL CHANGE AMONG RISK GROUPS ESPECIALLY THE YOUTH • USE DEADDICTED PATIENT FOR MOTIVATION NEW ADDICTS HIGH OF • SCHOOL CURRICULAM TO INCLUDE THE ADVERSE EFFECTS OF THE DRUG ABUSE AND CONTAMINATED NEEDLE USE • CONTROL DRUG TRAFFICKING ACROSS BORDER • MYANMAR REDUCE THE FREE ACCESSIBILITY AND AVAILABILITY OF DRUGS •UTILIZE PEERS (YOUTH ) TO BRING CHANGE IN YOUTH MIZORAM HIV CONTROL • PROVIDE EMPLOYMENT FOR YOUTH • FREQUENT RECURRENT VIOLENCE LEADS TO INSECURITY ,DESPAIR AND THEREBY RESORTING TO DRUG ABUSE. • DRUG INDUCED HALLUCINATIONS GIVE FALSE SECURITY AND FALSE COURAGE WHICH INTURN BREEDS VIOLENCE- • STEPS TO REDUCE VIOLENCE BY EDUCATING THE PEOPLE ABOUT EPIDEMIOLOGY OF VIOLENCE MIZORAM HIV CONTROL • CONTROLLING DRUG TAFFICKING ACROSS THE BORDER, • STRICT VIGILANCE OVER DRUG TRAFFICKERS, • INCOME GENERATING ACTIVITIES FOR UNEMPLOYED YOUTH, • PERSISTATANT PERSUAVASSIVE METHODS TO REDUCE IV DRUG USE HIV CONTROL AT EPICENTRES 2&3 (MAHARASHTRA,ANDHRA PRADESH, TAMILNADU &KARNATAKA) COMMERCIAL SEX WORK AND HIV CONTROL LICENCED BROTHELS WITH REGULAR SCREENING AND TREATMENT FOR STD , INCOME GENERATING ACTIVITIES FOR CSW, REHABILITATION OF THE CHILDREN AND DEPENDENTS OF CSW, STRICT ENFORCEMENT OF IMMORAL TRAFFIC REGULATION ACT STRICT VIGILANCE AND SCREENING FOR HIV AT DHABAS & NIGHT CLUBS CONDOM USAGE CONDOM USAGE IS A TEMPORARY INTERVENTION . IT IS ALSO NOT ETHICAL TO GIVE SOMEONE A CONDOM AND ASK HIM TOVISIT A BROTHEL . IN THE LONG RUN, IT WILL NOT HELP. BUT IT IS A MOST PRACTICAL AND FEASIBLE INTERVENTION BUT WHY IT IS USED LESS ? WHY LESS ACCEPTABLE? SEX WORKERS COMPLAINING THAT THEY ARE LOOSING THEIR BUSINESS IF THEY INSIST THEIR CLIENTS FOR CONDOM USE .HOW FAR IT IS TRUE? HOW TO IMPROVE COMPLAINCE OF CONDOM USAGE? I.E.C. ACTIVITIES HAVE TO BE MODIFIED TO ENHANCE CONDOM USAGE AND COMPLAINCE.PEER GROUP MOTIVATION MAY BE TRIED CONDUCTING EXHIBITIONS SHOWING VARIOUS MODELS AND SPECIMENS OF SEXUALLY TRANSMITTED DISEASES MAY CREATE INTEREST IN THE PUBLIC AND BECOME SENSITIZED FOR CONDOM USE. MCTC AND THROUGH INFECTED BLOOD • MOTHER TO CHILD TRANSMISSION (MCTC) • • • AS HIV IS HIGH IN ANTENATAL WOMEN (1%) , IT IS NECESSARY TO PREVENT MCTC. PREVENTION TRIALS ARE UNDERWAY IN ANDHRA PRADESH • HIV THROUGH INFECTED BLODD HAS COME DOWN INDIA DUE TO CLEARCUT TRANSFUSION POLICY STRICT LICENCING OF BLOOD BANKS AVOIDING BLOOD COLLECTION FROM PROFESSIONAL DONORS • • • LESS EFFECTIVE CONTROL FIRST GENERATION STD IN INDIA, CONTROL OF SEXUALLY TRANSMITTED DISEASES WAS NOT SERIOUSLY CONSIDERED THINKING THAT THEY ARE OF PERSONAL IN NATURE CLINICS FOR VENEREAL DISEASES WERE STARTED VERY MODESTLY . HIGH LEVEL SECRECY WAS MAINTAINED REGARDING STD,HENCE POOR PUBLIC AWARENESS AND INTURN LEAD TO RUMORS AND SUPERSTITIONS e.g. INTERCOURSE WITH A CHILD WILL RELIEVE STD & OPEN AIR URINATION CAUSES GONORRHEA TALKING ABOUT STD ITSELF USED AS A SIGN SOCIAL DEMORALISATION SCREENING FOR STD IN HIGH RISK GROUPS AND TREATING THE CASES WILL REDUCE THE VULNERABILITY FOR HIV AND THEREBY HIV INCIDENCE STD SYNDROMIC MANGEMENT SHOULD BE REALLY PRACTICED IN THE FIELD STD CONTROL AS IT IS INCLUDED IN NATIONAL AIDS CONTROL IS NOT GETTING ENOUGH ATTENTION • AIDS CONTROL SOCIETIES •FOR COMMUNITY INVOLVEMENT • HOW FAR THEY ARE SUCCESSFUL •IN REDUCING THE HIV INFECTION? •COMMUNITY PARTICIPATION HAS NOT REACHED ITS DESIRED LEVEL . •AS EVIDENCED BY •INCREASE IN HIV INFECTION •POOR USAGE OF CONDOMS •POOR AWARENESS AMONG BOTH URBAN AND RURAL POPULATION •ENRICH AND JUVENATE COMMUNITY INVOLVEMENT EITHER BY INCENTIVES OR DISCENTIVES.OR BY STRICT LEGISLATION •COORDINATION COMMITTEES SHOULD NOT BE CONFINED TO PAPER. •REAL INTERSECTORAL COORDINATION WITH RESPOSIBILITIES,WHICH ARE ACCOUNTABLE AND MONITORABLE, TO BE FIXED ON ALL SECTORS MASS MEDIA STRONG POSITIVE ROLE ESSENTIAL TV 9 CHANNEL INTERVIEWED CSW AT EAST GODAVARY DIST (AP) . CSW COMPLAINED THAT THEY ARE LOSING THEIR CLIENTS DUE TO HIV? FLIMS -SOME MOVIES ARE GIVING FALSE MESSAGES ABOUT HIV TRANSMISSION THROUGH THE COMEDIANS. EVEN FOR JOKE, WRONG MESSAGES SHOULD NOT BE GIVEN AS THEY BREED RUMORS AND SUPERSTITIONS AS HALF OF THE INDIAN COMMUNITY IS ILLTERATE. SUICIDES AFTER HIV POSITIVE DECLARATION ARE STILL HAPPENING.EFFECTIVE POST-TEST COUNSELLING IS IMPERATIVE CONCLUSION AS IT IS SECOND GENERATION STD, IT TACKLING AT PERSONAL LEVEL FIRST AS IT IS A LIFE STYLE DISEASE MODIFICATIONS ARE ESSENTIAL NEEDS , LIFE STYLE AS LONG AS FAVORABLE ENVIRONMENT AND SUSCEPTIBLE HOST IS AVAILABLE IT WILL BE SPREADING.HENCE NEED FOR STRESS ON LONG TERM STRATEGIES INSTEAD OF TEMPORARY BENEFITS TREATING AIDS PATIENTS IS ONLY HALF OF THE ANSWER AGRESSIVE HEALTH EDUCATION AT SCHOOL LEVEL (PRIMORDIAL PREVENTION ) IS RIGHT INTERVENTION BEFORE FIXED IDEAS DEVELOP.