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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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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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What has changed for people living with HIV?

Many experts feel that it’s time we moved beyond HIV/AIDS awareness campaigns and began seriously tackling the practical considerations of getting medicines to patients. Awareness is important, but it’s useless if we cannot provide the medicines, they tell Ranjita Biswas

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Zarina: 'We need more than information'

By Manjima Bhattacharjya

Zarina is just one of thousands of HIV-positive people caught between a government that cannot provide care and treatment to all, a private sector that is expensive and swarming with quacks, and NGOs that are driven by their own agendas

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Vaccine development: Still a shot in the dark

Despite many ongoing trials, a vaccine for HIV is still a distant goal, Dr Shahid Jameel of the International Centre for Genetic Engineering and Biotechnology tells Sandhya Srinivasan

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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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Transmission: Is it just about sex and drugs?

By Mariette Correa

Do we really know what the various forces driving India’s epidemic are? Some studies report that around 23% of medical injections could be using unsterile syringes or needles. WHO estimated that unsterile medical injections accounted for 24% of HIV transmission in India in 2000. But India has focused almost exclusively on the sexual route of transmission. Very little space is left for non-sexual routes of transmission. This has important implications for the prevention programme

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Moving beyond detoxification

By Eldred Tellis

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

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Why are AIDS drugs unaffordable in India?

By K M Gopakumar

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

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

By Mariette Correa

We know that HIV prevalence has stabilised or dropped in some parts of the country and amongst certain groups of the population. We know, for instance, that prevalence amongst female sex workers in Maharashtra has dropped from over 54% to 23%. And that prevalence in the general population in Tamil Nadu has dropped from 1% to .5%. But do we know why? An analysis of prevention efforts in India, the successes and failures, throws up more questions than answers

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Falling through the cracks: PPTCT in India

By Maya Indira Ganesh

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

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Do we need a separate law on HIV/AIDS?

By Kajal Bharadwaj

Stigma and discrimination lead to the most 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. But India has no existing legislation which would cover discrimination on the grounds of HIV. And the framework of public health legislation is too limited to adequately cover HIV issues

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Is premarital HIV testing feasible - or desirable?

By Manjima Bhattacharjya

Three states are considering legislation on compulsory HIV testing before registration of marriage. Public health activists, however, 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

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What are the challenges in conducting clinical trials for an HIV vaccine?

By Sandhya Srinivasan

India recently completed its first clinical trial for an HIV candidate, a Phase 1 safety trial at the National AIDS Research Institute, Pune. A second Phase 1 trial is ongoing at the Tuberculosis Research Centre (TRC), Chennai. Sanjay Mehendale, Deputy Director of the National AIDS Research Institute (NARI), discusses the logistical and ethical issues involved in running a trial for an HIV vaccine

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