AIDS in India could become as dire as in Africa

The epidemic of HIV/AIDS in India is following the same pattern as that of sub-Saharan Africa in the 1980s, and it could become just as devastating unless preventive action is taken now, according to researchers from the University of California, Berkeley, in a paper to be published Saturday (June 21) in the British Medical Journal. “In hindsight, opportunities were missed to stem the explosive growth of AIDS in Africa,” says Dr. Malcolm Potts, professor of population and family planning at UC Berkeley’s School of Public Health and lead author of the paper. “It would be a tragedy if we don’t apply the lessons learned from the failure to control the spread of HIV in Africa to the current situation in India. It is very painful to watch history repeating itself.”
From UC Berkeley:Researchers warn that AIDS in India could become as dire as in Africa

BERKELEY ? The epidemic of HIV/AIDS in India is following the same pattern as that of sub-Saharan Africa in the 1980s, and it could become just as devastating unless preventive action is taken now, according to researchers from the University of California, Berkeley, in a paper to be published Saturday (June 21) in the British Medical Journal.

“In hindsight, opportunities were missed to stem the explosive growth of AIDS in Africa,” says Dr. Malcolm Potts, professor of population and family planning at UC Berkeley’s School of Public Health and lead author of the paper. “It would be a tragedy if we don’t apply the lessons learned from the failure to control the spread of HIV in Africa to the current situation in India. It is very painful to watch history repeating itself.”

According to the Joint United Nations Programme on HIV/AIDS, 20 percent of people over 15 in some sub-Saharan African countries are HIV-positive, and 70 percent of them will eventually die from AIDS.

Recent estimates indicate the HIV prevalence rate in India, which has a population of 1 billion people, is less than 1 percent, but the low rate belies the looming pandemic on the horizon, according to the paper’s authors.

Part of the change comes from the shifting demographics of India over the past few decades. Like in Africa, large numbers of men in rural areas are migrating to the cities for work and being exposed to changing cultural values, the researchers say.

“Certain sexual practices that were inhibited in a village suddenly become easier with the anonymity that comes with living in a large city,” says Potts. “Men also start earning more money, so they have disposable income. And because the ratio of men to women is so low, the men spend their money on prostitutes, which contributes to the spread of HIV.”

A report from the CIA’s National Intelligence Council projects that the number of people infected with HIV in India will jump to 20-25 million by 2010. There is already evidence that, in some parts of India, HIV infection is moving from the core high-risk groups of prostitutes and intravenous drug users into the general population, the researchers say.

“In sub-Saharan Africa, not enough resources went towards effective prevention programs in these core high-risk groups,” says Potts. “The situation in India today parallels that of Africa 15 years ago.”

The authors are part of the Bay Area International Group (BIG), a family planning and reproductive health research group at UC Berkeley. Based upon an extensive literature review, original economic analyses and personal experience working in the fields of HIV prevention and international finance, the researchers concluded that current efforts to target high-risk groups in prevention programs fall far short of what is needed.

The paper notes that the public health expenditures for both India and sub-Saharan Africa fall below 6 percent of the gross domestic product. “Both India and Africa face similar challenges in that a large proportion of the population lives in poverty, and limited resources are available to help them,” says Dr. Julia Walsh, UC Berkeley adjunct professor of maternal and child health, co-author of the paper, and a co-director of BIG. “In India, the government spends a total of $12 per year per person on health care. Per capita, you’re lucky if get you get $1 per year spent on AIDS.”

“Investment in AIDS prevention has been a story of too little, too late,” says Potts. “The U.S. earmarked a mere $35 million globally for AIDS prevention in the mid-1980s. If we had had $200 million dedicated to AIDS prevention in Africa in the 1980s, the region would not be in the shape it is in now.”

With limited resources, it becomes even more important to use AIDS funds wisely, the researchers said. Yet, scarce funds are being wasted on a large number of small AIDS prevention pilot projects that cannot be scaled to the larger population and on large scientific meetings that have become “platforms for non-evidence based lobbying” rather than a forum for an exchange of ideas and collaborations, the authors say.

Moreover, funding for prevention efforts is in direct competition with funding for anti-retroviral (ARV) drugs. The researchers found that 60 percent of $378 million in grants from the Global Fund to Fight AIDS, Tuberculosis, and Malaria went towards HIV projects, and that 21 of 28 countries receiving those grants will use the money to purchase ARV drugs.

“With the exception of preventing mother-to-child transmission during birth, ARVs are difficult to use and are expensive in developing nations, even when drug companies greatly reduce the price,” says Walsh. “The most compelling lobbyists for extending ARV treatment to poor countries are infected individuals in rich countries. But evidence shows that focusing efforts on prevention rather than drug treatment can avert more infections and deaths from AIDS in developing nations.”

Another mistake made in the early years of the AIDS epidemic in Africa was the failure to act quickly on scientific evidence that sexually transmitted diseases (STDs) contribute to the spread of HIV by widely distributing condoms and subsidizing the use of antibiotics.

“We know these work, we just have to do it,” says Walsh. “Developing programs that helped those at highest risk for HIV transmission means dealing with groups that are marginalized in society: the prostitutes, IV drug users and men who have sex with men. There is still a traditional culture in

India, but political leaders must be willing to acknowledge the need to commit more resources to these core groups if they are to slow the spread of HIV.”

Evidence also has led the authors to recommend programs run by faith-based organizations, such as those in the Islamic, Christian and Hindu religions, that encourage sexual abstinence and a reduction in the number of sexual partners.

Another avenue of prevention advocated by the researchers is for HIV prevention programs to offer circumcision to Hindu men, who are generally not circumcised. This is based upon increasingly strong evidence that uncircumcised men are at significantly higher risk of becoming infected from an HIV-positive partner compared with circumcised men.

“We have a moral obligation to use the lessons learned from Africa to prevent a similarly catastrophic spread of HIV in India,” says Walsh. “This involves coordinated efforts from national governments, large agencies and donor groups. To do anything less is unethical.”

The Fred H. Bixby Endowment, the Bill and Melinda Gates Foundation and the William and Flora Hewlett Foundation provided funding for this research.

1 COMMENT

  1. Don’t Mistake India is going to HIV/AIDS epidemic

    Ms. Muslema Khan Bulon
    AIDS Researcher
    bulon.email@gmail.com

    HIV/AIDS is mounting in every country in the world. If we compare with other disease, it is only AIDS that will get significantly worse in every year. Other problems don’t grow but AIDS will overcome the medical alliance. The HIV/AIDS programme specialist Mr. Mohammad Khairul Alam said, “several social norms and immature behavior fueled of this disease to scatter rapidly. There are several social components link to develop this harmful situation. Poverty-behind to force it, Gender discrimination plays a vital role; Frustration & risk behavior help to sink humanity resulting infection. The link between poverty & gender discrimination are help to decline socio economic prosperity. This link creates several anti social poisonous issues also. Such as trafficking to prostitute, sell sex for earn or living, break down family norm to create frustration and driven drug point. We notice easily that Illiteracy is the main watchword of all circumstance. So it is not easy to remove it from the society, several programs & strategy are needed to gain sustainable position”.

    These findings are of concern when viewed against the general awareness levels of HIV/AIDS in India. For example, while close to 90 percent people in urban areas have heard of AIDS, only about 72 percent of people in the rural areas know about it. Tellingly, the study also highlights low awareness levels of HIV/AIDS in heavily populated states as a “danger signal”. About three out of four rural women in Bihar, Gujarat and Uttar Pradesh had never heard of HIV/AIDS.

    The ‘Rainbow Nari O Shishu Kallyan Foundation’ identified four major approaches in a groundbreaking study on spread out HIV in Asia. This study undertook by comparing of social-economic norm, family pattern, economic dependency, cause of mounting sex industries, gender discrimination status & global analysis fact. There are four factors that appear to play a crucial role in HIV transmission in Asian Countries: Injection/ intravenous drug use (By sharing needle), female sex work (Due to lack of safe sex knowledge), gender discrimination (which indirectly force females commercial or non-commercial sex), Same sex/ homosexually/ Hizra (Due to lack of HIV/AIDS information, because they act invisible in this society). Poverty & illiteracy fueled it proportionally.

    With regard to preventive measures, three out of ten men and five out of ten women were not aware of the condom’s protective value. Less than 30 percent of women in rural areas of Bihar, Gujarat, Uttar Pradesh and West Bengal were aware that HIV/AIDS could spread through blood transfusion. Only about 66 percent of women in urban areas but less than 50 percent in rural areas were aware of dangers of HIV-infected mothers breast feeding their children and possibly passing the infection on to the child.

    The most significant recent shift in drug use patterns in the region, as well as in India, is the move from smoking or chasing to injecting drug use. Heroin, buprenorphine (tidigesic/tamgesic) and dextropropoxyphene (spasmo-proxyvan) are the most commonly injected drugs in India.

    A Rapid Assessment Survey (RSA) of drug users in 14 cities collected and collated street-based information on drug use and drug-related HIV. In-depth thematic studies of drug use in the border areas, female drug users, drug use in rural areas and patterns of drug use in prison populations were also launched. A National Household Survey having a sample size of over 40,000 males in the 12-60 age group, documenting the extent, patterns and trends of drug use in India was a major part of the research collaboration.

    RSAs conducted in Jamshedpur, Hyderabad, Bangalore, Shillong, Dimapur, Thiruvanthapuram, Goa, Ahmedabad, Imphal, Chennai, Mumbai, Delhi and Kolkata indicate that 43 per cent of clients interviewed had injected at some point. Needle sharing was reported by 53-85 per cent of injectors. Non-cleaning of needles/syringes was common and knowledge of modes of HIV/AIDS transmission was limited. Consequently, risk-perception of HIV was low. Significantly, women drug users also reported injecting drug use. Clearly, there is need to extend interventions and prevention activities into areas other than the north-eastern states and particularly the metropolitan cities of India where injecting drug use is a problem. There are over 100,000 estimated injecting drug users in India outside of the north-eastern part of the country.

    References: SHYAM, Rainbow Nari O Shishu Kallyan Foundation

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