Care and support for people living with HIV/AIDS

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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
Report on the global HIV/AIDS epidemic – June 2000tripling to 1.25% between 1995 and 1997, the State Government acted decisively. Itset up an AIDS Society which worked closely with nongovernmental organizationsand other partners to develop an active AIDS prevention campaign. It hired a leadinginternational advertising agency to promote condom use for risky sex in a humorousway, without offending the many people who do not engage in risky behaviour.The campaign also attacked the ignorance and stigma associated with HIV infection,encouraging compassion for those affected.The bold safe-sex campaign has been a hit with its target market – young, sexuallyactive men. Regular behavioural surveillance shows that the number of visits to sexworkers and sex with other irregular partners has fallen, and condom use during riskysexual encounters has risen dramatically.Figure 4.%70Proportion of men reporting casual sex in the past year andcondom use with their last non-regular partner, Tamil Nadu,India, 1996-199860504030casual sex, truckerscasual sex, factory workerscondom use, truckerscondom use, factory workers201001996 1997 1998Source: AIDS Prevention and Control Project, Tamil Nadu, India, 1999Figure 4 shows that more men than before decided to avoid sex with non-regularpartners, while men who continued to have casual sex were far more likely to use acondom. The groups illustrated here – factory workers and truck drivers – are thoughtto represent men with a medium and a high likelihood, respectively, of engaging inrisky sexual behaviour.Thailand’s well-publicized success in curbing a rampant heterosexual epidemic hasbrought to light other routes of transmission against which HIV prevention programmeshave been far less successful. HIV continues to spread virtually unchecked14
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Opening new doors with counselling
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Care and support for people living
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National responses to the epidemic:
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Table of country-specific HIV/AIDS
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Care and support for people living with HIV/AIDS

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