Does HIV surveillance reflect reality?

[Guest guest]

Routes of HIV transmission : Does surveillance reflect reality?

Mariette Correa, PhD, Independent researcher

Email: mariettec@...

Gisselquist, PhD, Independent consultant

Email: david_gisselquist@...

Hans Einar Hem, Regional Representative, NCA(South Asia)

Email: hehem@...

Paper based on poster presentation at 5th International Conference on

AIDS India, Chennai, 20-25 October 2005

Abstract

Estimates of the proportions of HIV infections from various routes of

transmission in India have been based on AIDS case surveillance, which includes

for each case an assessment of the risk exposure that led to HIV infection.

We have studied this system of surveillance in one high prevalence district in

each of four Indian states, viz. Tamil Nadu, Karnataka, Maharashtra and Goa.

We find that AIDS case surveillance as a basis for determining the routes of HIV

transmission in India has serious weaknesses, and has produced unreliable

results.

Systems in hospitals to collect information on the routes of HIV transmission

are not standardised. Formats to report risks are not structured to facilitate

objective risk assessments. Attribution of AIDS cases to specific risks is often

based on assumptions, moral judgements and misinformation about the transmission

efficiency of HIV through various routes. Heterosexual sex has often been the

default category for risk attribution.

Failure of surveillance systems to capture non-sexual routes of transmission may

have led to a neglect of policies and interventions to prevent HIV spread

through these routes and may have intensified the stigma surrounding HIV/AIDS.

Strengthening surveillance systems would assist understanding of epidemic trends

and inform prevention strategies.

For further discussion on the issue or the detailed paper, please

contact Mariette or .

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Mariette Correa

1016, Muddo,

P.O. Carona,

Bardez, Goa 403523.

Tel: 91-832-2293766

email: mariette@...