Re: Targeted intervention hitting target in Kerala

[Guest guest]

Combined messages (Moderator)

Give more focus to " in " and " out " -migrants of Kerala.

Joy Cyriac

Active discussion on the scientific basis of interventions in Kerala

Dr.Ajith Kumar

Why funds are being allocated to only 'high prevalent states'.

Shiv Nair

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Give more focus to " in " and " out " -migrants of Kerala.

Joy cyriac

I am much grateful to Dr .Prasannakumar for his valuable opinion, but I still

afraid that he is assuming " perceived risk " is more important than the " real

risk " on commenting on the current HIV/AIDS policy of Targeted Intervention in

Kerala.

I certainly support Targeted Intervention (TI) program as a precautionary

step. Dr. Prasannakumar says that infected migrant group probably pass HIV to

their spouses and children only. If that was true I doubted HIV prevalence in

Kerala should not have risen to 75,000 to one lack (I think it is the rough

estimate of KSACS)

If the HIV prevalence in Female Sex Workers (FSWs) and Men who is having sex

with Mean (MSMs) below 2% again this figure is not matching. It is doubted that

border sharing towns of Kerala to Tamilnad especially in Plakkad,

Thiruvanthapuram and some part of Idduki district where the culture and social

systems are resembled to high prevalence state, the epidemic is spreading to the

general public. The migrant youth is passing the infectioni to central Kerala.

In central Kerala the infections reported were mainly form

Maharastra and Gujarat.

Only relying prevalence rate from pregnant women may not be the indicator that

HIV is not spreading to general community. If the present rough estimate of HIV

prevalence is 75000 has any one to say the percentage of infection passed from

high-risk groups and migrants? If the percentage is more from migrant community

certainly we have to give more focus to " in " and " out " -migrants of Kerala.

Thanking you

Joy cyriac

E-mail: <joycyriac2000@...>

______________________________

Active discussion on the scientific basis of interventions in Kerala

Dr.Ajith Kumar

It is interesting to note the active discussion on the scientific basis of

interventions in Kerala and the need for Kerala specific Intervention.

It is of no doubt that TI has made impact in the HIV epidemic in low income

target groups. Also TI and related interventions has helped to establish the

identity of this group in the society. But what ever done should be sustainable!

The real impact of Ties in Kerala is yet to be seen.As a clinician seeing at

least one new HIV positive a day,we are seeing a significant number of sick

patients never gone outside Kerala .This means disease was spreading beyond the

high risk group few years back. We see this phenomenon especially from a

particular district.(I do agree that this only an observation-not a result of

scientific study). Many of this infections were not exactly through

conventional commercial sex which is covered by TI.

I agree with Dr Prasannakumar that returning migrants are not fuelling the

epidemic.But migrant leaving the state are at risk and we should have a program

for them. Also a significant proportion of our patients are spouses and

children.That means we are seeing a different type of epidemic . Just because

they are unlikely to spread the disease we cannot ignore this group.

Also we should have programs to attract people to VCTCs( unfortunately many

proposed VCTCs are not yet functional and where ever it works there is doubt how

prominent the V is). Is it not possible to train some staff in District and

health centres in pre test counselling and make the Rapid tests available in

them.Positives can be referred to higher centres.Any way that is happening now

even after tests in VCTC because many of the VCTCs does not actually does not

have treatment centres attached to them.

It is true that the epidemic is slow in kerala in comparison to other high risk

areas but our aim should be no new cases from Kerala.

ART program is definitely a step in right direction and we should have more

Kerala specific programs than blindly following the international and national

programs.

Dr.Ajith Kumar

E-mail: <trc_ajisudha@...>

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Why funds are being allocated to only 'high prevalent states'.

Shiv Nair

Many HIV-AIDS organisations, SACS and Donors are involved with TIs in many

states. I understand everybody feels that HIV virus is spreading all over the

country uniformly, then why organisations are only targetting with so called '

high risk groups only'. Why funds are being allocated to only 'high prevalent

states'.

I understand high prevalence is based on effective Surveillance systems which

leads to good reporting. After initiating SACS in Jharkhand, within a month 59

cases of HIV reported tough they didn't share it with development

organisations. Does it mean we still continue to work in high prevalent states

as well just involved with TIs?

I support the view of Dr. Prasanna Kumar written to the moderator. Hope we

initiate similar interventions in low prevalent states as well as with community

at large soon.

Many thanks,

Shiv Nair

E-mail: <shivnair1123@...>