Care and support for people living with HIV/AIDS
Care and support for people living with HIV/AIDS
Care and support for people living with HIV/AIDS
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<strong>AIDS</strong> in a new millennium: a grim picture <strong>with</strong> glimmers of hopeIn parts of north-east India, widespread injecting drug use provided an easy earlyentry-point <strong>for</strong> <strong>HIV</strong>. In Manipur, the prevalence of <strong>HIV</strong> infection among injecting drugusers shot up from virtually nothing in 1988 to over 70% just four years later, <strong>and</strong> ithas remained at these high levels ever since. Predictably, since almost all injectingdrug users in the state are men, <strong>HIV</strong> then spread to their wives <strong>and</strong> girlfriendsthrough unprotected sex. Around 2.2% of pregnant women in Manipur tested positive<strong>for</strong> <strong>HIV</strong> in 1999. In other states, even higher levels of <strong>HIV</strong> have been recordedamong pregnant women. Most cases of infection appear to have been acquired fromhusb<strong>and</strong>s who had been infected in turn by sex workers, themselves part of a longerchain of transmission. By the mid-1990s, a quarter or more of sex workers in citiessuch as New Delhi, Hyderabad, Madurai, Pune, Tirupati <strong>and</strong> Vellore tested positive<strong>for</strong> <strong>HIV</strong>. In Mumbai, the prevalence of <strong>HIV</strong> infection among sex workers reached 71%in 1997.The Indian Government <strong>and</strong> individual state governments have launched preventionprogrammes to reduce high-risk sex, <strong>and</strong> there is evidence that in some states theseprogrammes are resulting in safer behaviour (see Box 2 below). If current preventionef<strong>for</strong>ts can be scaled up <strong>and</strong> sustained, India may be able to bring down the ratesof <strong>HIV</strong> infection in particularly exposed groups <strong>and</strong> avert a widespread heterosexualepidemic.Box 2. A measure of success: changing behaviour in Tamil NaduIt is important to collect in<strong>for</strong>mation about the behaviour that spreads <strong>HIV</strong> as well asabout the progress of the virus itself. It is very difficult to track new infectionsbecause <strong>HIV</strong> typically causes no symptoms <strong>for</strong> many years. The proportion of thepopulation infected – the <strong>HIV</strong> prevalence rate – is not a reliable indicator of recenttrends in risky behaviour; it encompasses all <strong>people</strong> <strong>with</strong> <strong>HIV</strong>, including those whobecame infected many years previously. In<strong>for</strong>mation about behaviour can be a usefulearly warning in countries where the virus is rare or confined to particular groups<strong>and</strong> can help explain changes in <strong>HIV</strong> prevalence in populations where the virus isalready well established. Behavioural in<strong>for</strong>mation also helps to monitor progress inpromoting safe sexual behaviour <strong>and</strong> hence shows the impact of national preventionprogrammes.In countries where <strong>HIV</strong> is widespread, data on sexual behaviour are collected frommen <strong>and</strong> women in households chosen r<strong>and</strong>omly as representative of the generalpopulation. In countries where <strong>HIV</strong> infection is less prevalent, it is more common toconduct surveys among occupational groups – such as soldiers, factory workers orsex workers – that typify different levels of risk <strong>and</strong> that can be contacted regularlyover time.When surveillance systems in the Indian state of Tamil Nadu – home to some 60 million<strong>people</strong> – showed that <strong>HIV</strong> infection rates among pregnant women were rising,–––>13