Care and support for people living with HIV/AIDS

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