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Sex education: need acknowledged, programme ignored

With 34% of all HIV cases occurring in the 15-24 age group, imparting sexuality education to adolescents could be crucial for containing HIV/AIDS. But in India, where sexual taboos are strong, neither teachers nor parents are happy discussing the facts about sexuality with youngsters, writes Shabnam Minwalla

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Hard questions about HIV/AIDS

Though HIV/AIDS has generated more attention than any other healthcare issue in India, we’re still struggling with many basic questions. For example, do we really know the relative importance of the different means of HIV transmission? Does the focus on sexual transmission and injecting drug use shift the responsibility of prevention to individuals rather than the system? How can a prevention programme work if it is targeted at people involved in practices that are seen as illegal? Sandhya Srinivasan gives some answers

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Sex workers demand a voice at international forums

At the recently concluded international AIDS conference in Mexico, and other forums, organisations of sex workers have demanded a greater say in AIDS policy formation. Ranjita Biswas reports

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Dangerous distortions?

UNAIDS's Redefining AIDS in Asia: Crafting an Effective Response, a comprehensive review of the realities and impact of AIDS in Asia, misses some vital causes of the spread of the epidemic such as unsafe practices in public health services and makes some faulty assumptions about Asia’s HIV epidemics, say Mariette Correa and David Gisselquist

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Male circumcision: a cut above?

Recent studies in Africa have suggested that male circumcision can halve the risk of HIV infection and a WHO meeting declared that male circumcision should now be recognised as an important intervention to reduce the risk of HIV. Mariette Correa assesses the evidence and the implications to public health and cultural concerns if this intervention is widely implemented in India

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20 million or 2 million?

In 2006, UNAIDS declared that India had 5.7 million HIV-positive people. NACO put the figure at 5.2 million. And, finally, NFHS-3 put the HIV burden at 2.5 million. M Prasanna Kumar demystifies the numbers game

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Is HIV/AIDS skewing the priorities of the public health system?

By T K Rajalakshmi

The bulk of health problems facing Indian people are simple -- malnutrition, malaria, diarrhoeal diseases, etc – and they require simple solutions -- food, mosquito control and clean water. But the government’s approach to public health increasingly focuses on vertical programmes to tackle each disease instead of comprehensive healthcare. The AIDS control programme is another vertical programme that reinforces our misplaced priorities, and also puts more pressure on an already crumbling public health infrastructure

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Why do less than half of those who require ART get treatment?

Despite the fact that India is a major producer of cheap generic HIV and AIDS drugs, India’s ART programme is poorly conceived, implemented and monitored, with a shortage of drugs, equipment and personnel. Such an unprepared public health system is in no position to handle such an intensive programme, say Sandhya Srinivasan and T K Rajalakshmi

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Criminalising high-risk groups such as MSM

All three core groups affected and infected in the HIV epidemic -- men having sex with men, sex workers and injecting drug users -- are criminalised in India. How can any intervention work amongst groups whose behaviour is criminalised? Ashok Row Kavi calls for basic structural changes, including the deletion, or at least reading down, of Section 377 of the Indian Penal Code on sodomy, decriminalising sex work and curbing narcotics trafficking instead of punishing end-users

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Moving beyond detoxification

The prevalence of HIV amongst injecting drug users in India could be more than 5%. But the only government intervention for these hidden, marginalised people is detoxification. Those who cannot obtain treatment and continue to inject drugs, or those who relapse, need other methods for reducing the risk of HIV transmission, including community outreach, the provision of new needles and syringes, condom provision and drug substitution therapy, says Eldred Tellis

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Why are AIDS drugs unaffordable in India?

The big question facing HIV-positive people in India is access to affordable antiretroviral drugs. Already, second-line drugs cost over Rs 1 lakh per person per year in India, compared to approximately Rs 50,000 in 66 other developing countries. K M Gopakumar outlines some measures the government can take to rein in prices

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Prevention of HIV transmission: Do we know what works and what doesn't?

We know that HIV prevalence has stabilised or dropped in some parts of the country and amongst certain groups of the population. But do we know why? Mariette Correa analyses prevention efforts in India, the successes and failures

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Falling through the cracks: PPTCT in India

Parent to child transmission of HIV in India infects 56,700 children every year. The third phase of the National AIDS Control Programme aims to reach 7.5 million women and give prophylactic treatment to 75,600 infected mother-baby pairs. The task is ambitious: in 2005, just 2.9 million women were reached, though the target was 6.9 million. Maya Indira Ganesh explains what more needs to be done

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Do we need a separate law on HIV/AIDS?

Stigma and discrimination lead to significant human rights violations for persons living with HIV/AIDS and are the greatest barriers to preventing further infection and providing care, support and treatment. Yet India has no existing legislation which would cover discrimination on the grounds of HIV, says Kajal Bharadwaj

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Is premarital HIV testing feasible – or desirable?

Three states are considering legislation on compulsory HIV testing before registration of marriage. Public health activists point out that premarital counselling and life skills education, not compulsory testing, are more likely to ensure behavioural change. Such a law might end up increasing the social ostracisation of the HIV-positive, adversely affecting women, the very group the law sets out to protect, says. Manjima Bhattacharjya

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HIV and breastfeeding

In many countries HIV- positive women are told to prevent transmission of the virus to their newborn child by giving them food other than breast milk. But in India, infants denied breast milk may be at risk of malnutrition as well as serious food borne infections. Jayashree A Mondkar looks at the risks and benefits of breastfeeding

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Blood safety and informing donors of their HIV status

In order to provide safe blood for donation, blood banks must test each unit for HIV as well as a number of other infections. Since banks thus obtain information on a donor’s HIV status, should this information be given to the donor? S N Misra explores this controversial issue

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4 lakh AIDS deaths in India: 'It is pure mathematics'

In an interview with Rashme Sehgal, Denis Broun, country representative of UNAIDS, defends a recently-published report by his organisation that states that over 4 lakh AIDS-related deaths occurred in India in 2005 -- the highest in the world

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Why life-saving drugs should be public goods

Rachana Kamtekar counters the argument that if the motivation of high profits is removed, private companies will cease research into life-saving drugs. Most people in the developing world benefit less from privatised medical research than they would from medical research driven by health needs and funded publicly, she says

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Access to AIDS medicine: ethical considerations

AIDS medicines should not be viewed as private property from which huge profits can be derived, argues Omar Swartz. To fail to reduce the suffering of people afflicted with AIDS on the grounds that one person 'owns' the medicine and another has no right to it without payment of a premium is so completely reprehensible that it should be beyond acceptance and legal protection in civilised society

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