Update on comprehensive care and support services, at Jodhpur, Rajasthan INDIA

[Guest guest]

Dear Forum Members,

According to the report of UNICEF, India's socio-economic status, traditional

social skills, cultural myths on sex and sexuality and a huge population of

marginalized people make it extremely vulnerable to the HIV/AIDS epidemic. With

five million-plus HIV/AIDS patients, India as whole is itself rivaling the

world's AIDS capital, South Africa. Government is fighting on with massive

efforts, but it is still too less or too late for millions of impoverished

Indians, mostly in rural areas, who either have little clue about the disease or

are hiding it from others for fear of being ostracized.

In such a situation, it is the action that is required, an action which is

effective and which addresses the needs of those who are facing the HIV

infection. The new beginning that started as a result of closure of AFXB program

has received tremendous response from those infected with HIV. With peanut range

of services presently available around 160 people have registered themselves for

treatment in a period of three months. Response like this proves once again the

need and efficacy of such programs in resource-limited settings.

At the same time, I am happy to inform the forum that the research thesis

written by a Harvard student based on the data of the care and support program-

in Jodhpur - has been awarded the best thesis by the Harvard School of Public

Health.

Following is the Acknowledgement and Abstract of thesis. Very talented student

“Aakanksa Pande” wrote it. The subject and finding are of tremendous use for all

of us, as more and more programs for treatment of HIV are getting operational.

Acknowledgments

------------------

The data, analysis, and material presented in this thesis would not have been

possible without the input of many people. In particular I would like to thank

the following three groups:

Firstly, my parents, Girija and Bharoti Pande, for their unflagging support and

encouragement of all my academic endeavors; my brother, Rahul, for teaching me

to critically evaluate research; and my grandmother for instilling in me the

importance of hard work.

Secondly, my gratitude is to my professors and colleagues at the Harvard School

of Public Health. I would especially like to thank Salomon for his

painstaking input into each iteration of this document; Bloom for his

overall guidance and help in locating a dataset; Cash, Jaypee Sevilla,

and Ajay Mahal for sharing their research on this topic; and Reich,

advisor and mentor extraordinaire. I am grateful to the support from HSPH for my

winter session trip to this clinic and the effort of Marks in organizing

this trip. I also appreciate the wisdom and wit of my colleagues over the course

of my two years at HSPH: Rifat Hasan and my co-board members at AIDS Tank--

Ferguson, Lamb, and Sabina Haberlen.

Finally, this thesis is dedicated to the staff of the erstwhile FXB Care and

Treatment Clinic in Jodhpur, India. I thank Dr. Garg for giving me permission to

use this data, and Trupti Desai for assembling the data set. I appreciate the

guidance and warmth extended to me by Dr. K.C. Joshi, Rashmi Rathore, Bhawna

Sati, and Trupti Desai. Most importantly, I would like to thank Dr. Garg for

providing me with a living example of how the Gandhian values of service to

patients above service to self can be possible even in a severely resource

constrained setting.

Abstract

-----------------

This longitudinal retrospective study examines the association between highly

active antiretroviral therapy (HAART) and changes in sexual behavior among a

cohort of 619 HIV positive patients in Jodhpur, India from 2001-2004. The

central hypothesis examined is that the use of HAART promotes a lower perception

of the risk of HIV infection, leading to an increase in risky sexual behavior

and ultimately an increase in new HIV infection.

Results from the logistic regression analyses suggest that after accounting for

significant covariates, being on HAART was not significantly associated with

changes in sexual behavior [Odds Ratio, OR: 1.38; 95% CI: 0.62, 3.05].

Similarly, multinomial regression analyses of the effect of HAART on condom use

and on sexual frequency suggest that HAART had a positive but insignificant

association with decreasing sexual frequency [OR: 1.08; 95% CI: 0.47, 2.47] and

a positive but insignificant association with increasing condom use [OR: 1.42;

95% CI: 0.74,

3.77]. However, interventions associated with HAART were significantly

associated with change in sexual frequency.

For example, psychological counseling was significantly positively associated

with preventive sexual behavior [OR: 1.18; 95% CI: 1.03, 1.35]. The results from

this study reinforce the importance of interventions that tackle perceptions of

risk in reducing high-risk sexual behavior. It suggests that while being on

HAART does not appear to significantly affect sexual behavior, the package of

interventions associated with HAART could have a strong protective effect. As a

result, an approach that recognizes the complementary roles of treatment and

prevention, and the importance of both in the efforts to check this epidemic is

required.

A thing like this motivates us to continue our work but how far we can go with

limited resources is a million dollar question. I would like to quote what T.S.

Eliot once said.

“Only those who will risk going too far can possibly find out how far one can

go.”

Regards,

IN SOLIDARITY,

Trupti Desai

e-MAIL: <truptid_69@...>