1. SOIL AND SHOWER OF HIV / AIDS IN INDIA HIV(seed)
DISCUSSION FROM A DIFFERENT ANGLE
Dr. A.K.AVASARALA, MD
PROFESSOR & HEAD
DEPARTMENT OF COMMUNTIY MEDICINE AND EPIDEMIOLOGY
PRATHIMA INSTIUTE OF MEDICAL SCIENCES,
NAGUNUR, KARIMNAGAR ( A.P.), INDIA –
E_mail :
ENVIRONMENT (SHOWER)
HOST
(SOIL))

2. HIV INFECTION NO DOUBT IT INVADED SETTLED SPREADING IN INDIA
UNAIDS FACT SHEET 2003
HETEROSEXUALS ( SEX WORKERS )-60-70%
ANTENATAL WOMEN - 1 %
HOMOSEXUALS – 27 % ( NACO, INDIA)

3. HIV/AIDS IN INDIA HETEROGENEOUS DISTRIBUTION
GENRALIZED CONCETRATED
EPIDEMIC EPIDEMIC
>5% in high risk groups+ >1% (>5% IN HIGH RISK +<1% IN PREGNANT WOMEN PREGNANT WOMEN
MAHARSHTRA,TAMILNADU,KARNATAKA, GUJARATH,GOA,KERALA,WESTBENGAL
ANDHRA PRADESH,MANIPUR NAGALAND
LOW LEVEL
EPIDEMIC (<5% IN HIGH RISK+<1% IN PREGNANT WOMEN
UTTAR PRDESH,MADHYA PRADESH,BIHAR,RAJASTHAN
REST OF INDIA
vulnerable WITH HIGH
STD
PREVALENCE

4. HIV/AIDS IN INDIA
HR > 5 , PW > 1% MAHARASHTRA,TAMILNADU,KARNATAKA,ANDHRAPRADESH,MANIPUR
HR > 5% , PW < 1% GUJARATH, GOA, WESTBENGAL, NAGALAND
HR < 5% , PW < 1% UTTARPRADESH,MADHYAPRADESH,BIHAR, RAJASTHAN

5. SENTINEL SURVEILLANCE DATA IN METROPOLITAN CITIES

6. DUE TO POOR LITERACY & UNAWARNESS
RURAL SITUATION
ALSO NOT SATISFACTORY
MORE HIV SEEN
DUE TO POOR LITERACY & UNAWARNESS
AND LESS CONDOM USE

7. 3. ANDHRA PRADESH & KARANATAKA, AND TAMILNADU
3 EPICENTRES
MEGHALYA, MANIPUR & MIZORAM
MAHARASTRA
3. ANDHRA PRADESH & KARANATAKA,
AND TAMILNADU

8. EPICENTRE -1 (SOIL &SHOWER) FERTILE SOIL(SUSCEPTIBLE HOST)
MEGHALAYA, MANIPUR AND MIZORAM
FERTILE SOIL(SUSCEPTIBLE HOST)
POOR AND UNEMPLOYED
YOUNG AND IMMATURE, ANTISOCIAL
TEMPTED TO INJECTABLE DRUG ABUSE
CALLOUS , HENCE CONTAMINATION OF NEEDLES
SHOWER (FAVOURABLE ENVIRONMENT)
FREE AVALIBILITY OF NARCOTIC DRUGS DUE TO
DRUG TRAFFICKING ACROSS THE MYANMAR BORDER and POLITICAL INSTABILITY favors HIV INFECTION
? CAN FREE SUPPLY OF STERILE NEEDLES
SOLVE THIS PROBLEM ? IS IT ETHICAL?

9. CONFOUNDING SITUATION AT MIZORAM
VIOLENCE
POLITICAL INSTABILITY
FALSE SECURITY
FALSE COURAGE
UNEMPLOYMENT &
IDLE YOUTH
HALLUCINATIONS
DELUSIONS
DRUG ABUSE& HIV
FREELY AVAILABLE
DRUGS

10. EPICENTRES-2&3 (SOIL &SHOWER)
MAHARASTRA, ANDHRA PRADESH, TAMILNADU, KARANATAKA
SHOWER
POVERTY,
MUMBAI,PUNE,SATARA.CHENNAI,
VIJAYAWADA(AP)
WITH THEIR GROWING URBAN SLUMS AND MOBILE POPULATION,
COMMERCIAL SEX WORK(CSW)
LACK OF BROTHEL LICENCING,
LACK OF MEDICAL EXAM FOR CSW
SOIL
UNSAFE SEX , ILLEGAL SEX
COMMERCIAL SEX WORK
MULTIPLE SEX PARTNERS
LESS CONDOM USE
HUNGER, ILLITERACY,
CARELESSNESS, SEXUAL PERVERSIONS

11. (WAYSIDE FEEDING CENTRES OF ILLFAME)
EPICENTRES 2&3 DHABHAS
(WAYSIDE FEEDING CENTRES OF ILLFAME)
OTHER SIDE OF THE COIN
BIG BUSINESS
LONG DISTANCE
TRUCK DIVERS
CONTRACTORS ENOLL SEXWORKERS AND DROP THEM AT DHABHAS IN THE EVENING AND COLLECT THEM IN THE MORNING THEY COLLECT COMMISSION FROM CSW.
DHABHA OWNER IS ALSO BENFITED DUE TO MORE NUMBER OF CUSTOMERS WEAK ENFORCEMENT OF RESTRICTION OF IMMORAL TRAFFIC ACT IS ANOTHER FACTOR.
LEAVING THEIR
WIVES AT HOME
LONELINESS,
RESORT TO ILLICIT CHEAP SEX
AT DHABHAS
HIV
SEEDLING ALONG HIGHWAYS

12. WHY HIV INVADED&SETTLED INDIA
INDIAN SOCIETY CHANGED IN FAVOUR OF
HIV -

13. 5
HIV / AIDS IN INDIA IS
NOT
JUST DUE TO
HIV ALONE (THE SEED)

14. SOCIETAL CHANGE (SHOWER)
ACCULTURATION EFFECTS
CULTURAL CHANGES--INCREASE IN -VE LIFE STYLES REGARDIG SEXUAL PRACTICES
DETERIORATED HUMAN VALUES
SEXUAL PERVERSIONS AND STD ON THE RISE
COSMOPOLITAN NATURE OF CITIES ENCOURAGING -VE LIFESTYLES
URBAN SLUMS & NIGHT CLUBS -MORE OPPORTUNITIES FOR ILLEGAL AND UNSAFE SEX
INCREASING MOBILE POPULATION AT BUSSINESS CENTRES AND CITIES FAVOURING THE SPREAD
COMPLACENCY ABOUT UNIVERSAL PRECAUTIONS &SEXUALLY TRANSMITTED DISEASES

15. HUMAN VALUES &VIRTUES AT LOW LEVEL CELIBECY NOT PRACTICED
DETERIORATION
MONOGAMY AT THREAT
HUMAN VALUES &VIRTUES AT LOW LEVEL
CELIBECY NOT PRACTICED

16. ESPECIALLY IN COSMOPOLITAN CITIES
INCREASING SEX ABUSE
ESPECIALLY IN COSMOPOLITAN CITIES
DUE TO
FREE AVAILABILITY OF SEX
COMMERCIAL SEX WORK AND SEX MARKETTING
NIGHT CLUBS AND CALL GIRL SYSTEM
ILLEGAL SEX
MULTIPLE PARTNERS

17. HIV IS A MAJOR BEHAVIORAL PROBLEM
SEXUAL PERVERSIONS
HIV IS A MAJOR BEHAVIORAL PROBLEM
HOMOSEXUALITY -- INCREASE IN
THE LONELY
ORAL SEX
ANAL SEX- CHILD ABUSE

18. CONTROL ASPECTS

19. CSW &INJECTABLE DRUG USERS(IDU)
SPREAD OF HIV
CLIENTS OF CSW,
STD PATIENTS,
PEERS OF I.D.USERS
CSW &INJECTABLE DRUG USERS(IDU)
(HIGH RISK)
GENERAL
POPULATION
(BRIDGE)

20. HIV (THE SEED)
WHY HIV IS PREFERRING T4 CELLS ONLY NOT OTHER CELLS
WHAT IN T4 CELLS THAT IS ATTRACTING HIV ?
CAN THAT SOMETHING CAN BE ELIMINATED OR NEUTRALIZED ?

21. LIFE STYLE MODIFICATIONS-TOP PRIORITY
“ MEND THE MIND MUST BE THE RULE AS HIV IS MAINLY A BEHAVIORAL DISORDER
LIFE STYLE MODIFICATIONS ARE NOT GIVEN ENOUGH STRESS AT PRESENT
ETHICAL VALUE OF SAFE SEX NOT MUCH EMPHASIZED
CHARACTER-BUILDING NOT ATTEMPTED
NO STRESS TO CURB DON’TS (-VE LIFE STYLES )

22. LIFE STYLE MODIFICATIONS
ONLY THE CHANGE OF BEHAVIOR CAN SOLVE THE HIV PROBLEM PERMANANTLY
IT IS NEITHER ADVISABLE NOR ETHICAL TO PROVIDE STERILE SYRINGES FREELY TO A DRUG ADDICT AND ASK HIM TO CONTINUE TO TAKE DRUGS NOR TO PROVIDE A CONDOM AND ASK TO VISIT A BROTHEL, BECAUSE IN BOTH THE STRATEGIES, BEHAVIOR AL CHANGE TO CURB RISKY BEHAVIOR WILL NOT OCCUR BUT WILL CONTINUE. .

23. CONFOUNDING SITUATION
MIZORAM HIV CONTROL
CONFOUNDING SITUATION
BRINGOUT THE BEHAVIORAL CHANGE AMONG HIGH RISK GROUPS ESPECIALLY THE YOUTH
USE DEADDICTED PATIENT FOR MOTIVATION OF NEW ADDICTS
SCHOOL CURRICULAM TO INCLUDE THE ADVERSE EFFECTS OF THE DRUG ABUSE AND CONTAMINATED NEEDLE USE
CONTROL DRUG TRAFFICKING ACROSS MYANMAR BORDER
REDUCE THE FREE ACCESSIBILITY AND AVAILABILITY OF DRUGS
UTILIZE PEERS (YOUTH ) TO BRING CHANGE IN YOUTH

24. MIZORAM HIV CONTROL
PROVIDE EMPLOYMENT FOR YOUTH
FREQUENT RECURRENT VIOLENCE LEADS TO INSECURITY ,DESPAIR AND THEREBY RESORTING TO DRUG ABUSE.
DRUG INDUCED HALLUCINATIONS GIVE FALSE SECURITY AND FALSE COURAGE WHICH INTURN BREEDS VIOLENCE-
STEPS TO REDUCE VIOLENCE BY EDUCATING THE PEOPLE ABOUT EPIDEMIOLOGY OF VIOLENCE

25. MIZORAM HIV CONTROL CONTROLLING DRUG TAFFICKING ACROSS THE BORDER,
STRICT VIGILANCE OVER DRUG TRAFFICKERS,
INCOME GENERATING ACTIVITIES FOR UNEMPLOYED YOUTH,
PERSISTATANT PERSUAVASSIVE METHODS TO REDUCE IV DRUG USE

26. HIV CONTROL AT EPICENTRES 2&3 (MAHARASHTRA,ANDHRA PRADESH,
TAMILNADU &KARNATAKA)
COMMERCIAL SEX WORK AND HIV CONTROL
LICENCED BROTHELS WITH REGULAR SCREENING
AND TREATMENT FOR STD ,
INCOME GENERATING ACTIVITIES FOR CSW,
REHABILITATION OF THE CHILDREN AND DEPENDENTS
OF CSW,
STRICT ENFORCEMENT OF IMMORAL TRAFFIC
REGULATION ACT

27. STRICT VIGILANCE
AND SCREENING FOR HIV AT
DHABAS &
NIGHT CLUBS

28. CONDOM USAGE
CONDOM USAGE IS A TEMPORARY INTERVENTION . IT IS ALSO NOT ETHICAL TO GIVE SOMEONE A CONDOM AND ASK HIM TOVISIT A BROTHEL . IN THE LONG RUN, IT WILL NOT HELP.
BUT IT IS A MOST PRACTICAL AND FEASIBLE INTERVENTION BUT
WHY IT IS USED LESS ?
WHY LESS ACCEPTABLE?
SEX WORKERS COMPLAINING THAT THEY ARE LOOSING THEIR BUSINESS IF THEY INSIST THEIR CLIENTS FOR CONDOM USE .HOW FAR IT IS TRUE?
HOW TO IMPROVE COMPLAINCE OF CONDOM USAGE?
I.E.C. ACTIVITIES HAVE TO BE MODIFIED TO ENHANCE CONDOM USAGE AND COMPLAINCE.PEER GROUP MOTIVATION MAY BE TRIED
CONDUCTING EXHIBITIONS SHOWING VARIOUS MODELS AND SPECIMENS OF SEXUALLY TRANSMITTED DISEASES MAY CREATE INTEREST IN THE PUBLIC AND BECOME SENSITIZED FOR CONDOM USE.

29. MCTC AND THROUGH INFECTED BLOOD
MOTHER TO CHILD TRANSMISSION (MCTC)
AS HIV IS HIGH IN ANTENATAL WOMEN (1%) ,
IT IS NECESSARY TO PREVENT MCTC.
PREVENTION TRIALS ARE UNDERWAY IN
ANDHRA PRADESH
HIV THROUGH INFECTED BLODD HAS COME DOWN
INDIA DUE TO
CLEARCUT TRANSFUSION POLICY
STRICT LICENCING OF BLOOD BANKS
AVOIDING BLOOD COLLECTION FROM
PROFESSIONAL DONORS

30. LESS EFFECTIVE CONTROL FIRST GENERATION STD
IN INDIA, CONTROL OF SEXUALLY TRANSMITTED DISEASES WAS NOT SERIOUSLY CONSIDERED THINKING THAT THEY ARE OF PERSONAL IN NATURE
CLINICS FOR VENEREAL DISEASES WERE STARTED VERY MODESTLY
HIGH LEVEL SECRECY WAS MAINTAINED REGARDING STD,HENCE POOR PUBLIC AWARENESS AND INTURN LEAD TO RUMORS AND SUPERSTITIONS
e.g. INTERCOURSE WITH A CHILD WILL RELIEVE STD &
OPEN AIR URINATION CAUSES GONORRHEA
TALKING ABOUT STD ITSELF USED AS A SIGN SOCIAL DEMORALISATION
SCREENING FOR STD IN HIGH RISK GROUPS AND TREATING THE CASES WILL REDUCE THE VULNERABILITY FOR HIV AND THEREBY HIV INCIDENCE
STD SYNDROMIC MANGEMENT SHOULD BE REALLY PRACTICED IN THE FIELD
STD CONTROL AS IT IS INCLUDED IN NATIONAL AIDS CONTROL IS NOT GETTING ENOUGH ATTENTION .

31. AIDS CONTROL SOCIETIES
FOR COMMUNITY INVOLVEMENT
HOW FAR THEY ARE SUCCESSFUL
IN REDUCING THE HIV INFECTION?
COMMUNITY PARTICIPATION HAS NOT REACHED ITS DESIRED LEVEL .
AS EVIDENCED BY
INCREASE IN HIV INFECTION
POOR USAGE OF CONDOMS
POOR AWARENESS AMONG BOTH URBAN AND RURAL POPULATION
ENRICH AND JUVENATE COMMUNITY INVOLVEMENT EITHER BY INCENTIVES OR DISCENTIVES.OR BY STRICT LEGISLATION
COORDINATION COMMITTEES SHOULD NOT BE CONFINED TO PAPER.
REAL INTERSECTORAL COORDINATION WITH RESPOSIBILITIES,WHICH ARE ACCOUNTABLE AND MONITORABLE, TO BE FIXED ON ALL SECTORS

32. STRONG POSITIVE ROLE ESSENTIAL
MASS MEDIA
STRONG POSITIVE ROLE ESSENTIAL
TV 9 CHANNEL INTERVIEWED CSW AT EAST GODAVARY DIST (AP) . CSW COMPLAINED THAT THEY ARE LOSING THEIR CLIENTS DUE TO HIV?
FLIMS -SOME MOVIES ARE GIVING FALSE MESSAGES ABOUT HIV TRANSMISSION THROUGH THE COMEDIANS. EVEN FOR JOKE, WRONG MESSAGES SHOULD NOT BE GIVEN AS THEY BREED RUMORS AND SUPERSTITIONS AS HALF OF THE INDIAN COMMUNITY IS ILLTERATE.
SUICIDES AFTER HIV POSITIVE DECLARATION ARE STILL HAPPENING.EFFECTIVE POST-TEST COUNSELLING IS IMPERATIVE

33. CONCLUSION
AS IT IS SECOND GENERATION STD, IT NEEDS TACKLING AT PERSONAL LEVEL FIRST
AS IT IS A LIFE STYLE DISEASE , LIFE STYLE MODIFICATIONS ARE ESSENTIAL
AS LONG AS FAVORABLE ENVIRONMENT AND SUSCEPTIBLE HOST IS AVAILABLE IT WILL BE SPREADING.HENCE NEED FOR STRESS ON LONG TERM STRATEGIES INSTEAD OF TEMPORARY BENEFITS
TREATING AIDS PATIENTS IS ONLY HALF OF THE ANSWER
AGRESSIVE HEALTH EDUCATION AT SCHOOL LEVEL (PRIMORDIAL PREVENTION ) IS RIGHT INTERVENTION BEFORE FIXED IDEAS DEVELOP. .