Indian Army's fight against AIDS

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Army's fight against AIDS The armed forces have waged a tough battle against AIDS among its personnel. Thanks to a number of measures undertaken to combat HIV on a war-footing, the incidence of the life-threatening disease has declined sharply in the three services, reports Vijay Mohan

"Getting affected by the HIV virus is no crime, but hiding it is. Personnel can face punishment if they fail to disclose visits to sex workers. The services are trying to remove the stigma attached to the disease. We are sensitising officers and jawans about the dreaded disease, with bi-monthly lectures, slide-shows and video presentations." Surgeon Vice Admiral V.K. Singh, Director General, AFMS

Even as AIDS and HIV infection assumes epidemic proportions in the country, the armed forces appear to have controlled the spread of the deadly disease amongst its rank and file. In the year 2006, there was no case of AIDS reported in the defence services. Besides, proactive measures adopted by the forces has resulted in the number of military personnel testing positive for HIV dropping to just 37 last year, from about 300 cases detected three years ago. The rate of HIV cases among Indian troops is 0.028 per cent as compared to 0.09 in the civilian society. At 0.026 per cent, the rate of HIV cases in the US military, is only slightly lower than that in the Indian military. Incidentally, armed forces around the world face a serious risk of HIV infection and other sexually transmitted diseases (STDs) According to World Health Organisation estimates, about 40 million people worldwide are affected with HIV virus and over 25 million have died of AIDS. Studies reveal that in India, the number of HIV infections would touch 20-25 million by the end of 2010. The armed forces, which comes from the same society, are equally susceptible. Several bold measures have been taken to combat the spread of HIV/AIDS in the services. One such measure is making it mandatory for a soldier to report visits to sex workers to their superiors, so that treatment and remedial therapy can be started immediately. It is now established that if treatment begins within 24 hours of sexual contact, it can kill the HIV virus, if any, present in the body. "Getting affected by the HIV virus is no crime, but hiding it is," Surgeon Vice Admiral V.K. Singh, Director General, Armed Forces Medical Services (AFMS), said during a visit to the Command Hospital, Chandimandir, in December. "Personnel can face punishment if they fail to disclose visits to sex workers," he added. "More importantly," the admiral maintained, "the services are trying to remove the stigma attached to the disease. We are sensitising officers and jawans about the dreaded disease, with bi-monthly lectures, slide-shows and video presentations being organised at the battalion level," he added. The involvement of commanders and regimental officers, say experts, is essential for the successful prevention of HIV infection in the forces. A recent study by Brig Z. Singh, Commandant, Military Hospital, Jalandhar, and Lt Col A. Banerjee (retd), Associate Professor at Dr D.Y Patil Medical College, Pune, indicated that there was energetic advocacy on HIV prevention, including condom promotion, by regimental officers. Yet, wider dissemination of surveillance figures generated at AIDS Control Organisation of the Armed Forces Medical College was required for apprising the men about the menace of HIV. The study HIV Prevention in the Armed Forces: Perceptions and Attitudes of Regimental Officers, published about four months ago, revealed that less than 50 per cent of the respondents could correctly assess the burden of HIV/ AIDS in the forces. Only about 41 per cent felt HIV/AIDS was a problem serious enough to affect operational efficiency. A structured questionnaire was sent to 40 different Information, Education and Communication nodes to elicit the perception and attitude of commanders and regimental officers. From each station, 40 officers were randomly selected and information from 1002 respondents was analysed. A majority of the respondents had communicated with the troops on the subject of HIV/AIDS. The study brought out that the perceived threat of HIV being a problem in one's own unit was low, with only about 19 per cent considered it to be a problem in their unit. The study noted that over 53 per cent of the respondents felt that educational and other measures being undertaken now are inadequate to deal with the HIV menace. Another cause for concern was that only seven per cent felt the need for confidentiality while dealing with an HIV positive person in the unit. Lack of confidentiality, the study observed, would push the epidemic underground as people would not come forward for voluntary testing and, hence, would be counter productive to control measures. Though the use of condom was advocated, the need felt for it in the unit was not commensurate with the advocacy. Here, the study also referred to a survey, HIV/AIDS Prevention, Testing and Care in Current Military Medical Practice, conducted a few years ago in which questionnaires were sent to the armed forces of 119 countries. The survey, the findings of which echoed in the aforementioned study, stated that serious gaps existed in programme implementation, particularly in condom promotion. Soldiers were instructed about the importance of condom use, but the military did not supply them to the troops. A separate study on the Socio-Behavioural Profile of HIV Positive Personnel undertaken by Wg Cdr J Mukhopadhya and Gp Capt S.C. Kabra revealed that a majority of the affected had acquired the infection from commercial sex-workers. All the affected persons were aware of HIV prevention and over 77 per cent had said that condoms were easily available. Shockingly, over 70 per cent did not use them. This study concluded that there was a discernible gap between knowledge and the practice of safe sex. Adequate preventive knowledge, the study observed, did not always result in the practice of safe sex. Other negative attitudes like disciplinary action, isolation and segregation also need to be countered. In fact, there have been instances in the past, where HIV positive personnel in the services as well as paramilitary forces have moved court against their discharge from service. An overwhelming majority of the community leaders, the study observed, preferred to continue with soft option activities such as creating awareness rather than moving on to hard concrete options such as providing care and support, empowering and condom promotion. The study also found that Army and Navy officers had more experience in dealing with HIV positive personnel in their establishments than Air Force officers, perhaps due to lower prevalence of HIV in the Air Force. Another study done by Brig Y.K. Sharma, Col M.P.S. Sawhney and Col S.K. Sayal (retd) on the mode of detection of HIV infection stressed upon the need to encourage voluntary reporting and the importance of identifying more number of cases during acute retroviral syndrome and PGL stages. The study revealed that about 30 per cent of the HIV cases surveyed had already developed category-C conditions when they were detected to be HIV positive. The forces, per se, do not dismiss an HIV positive person and he is given all possible treatment in military hospitals. If he develops AIDS and his medical condition does not render him suitable for military service, he is discharged on medical grounds, but his treatment continues. As an added measure against HIV, the services have sent a proposal to the Ministry of Defence for compulsory HIV screening of recruits. The three services have already approved the plan and the assent of the ministry is awaited. The screening of military personnel for the virus would also be done every five years. Also on the cards is pre-induction and post-induction screening of troops deployed in the North-East and Jammu and Kashmir, and those going and returning from UN missions. Observing that HIV/AIDS is assuming dangerous proportions all over the country, Parliament's Standing Committee on Defence has stressed that the AFMS should be more vigilant in this regard and conduct regular awareness programmes to educate troops. It has also recommended that AFMS should initiate more research programmes in this field.

OTHER CURES The Armed Forces Medical Services (AFMS) rely solely on the allopathic system of treatment and do not use the traditional and alternate system of medicine. There is now a move to introduce ayurvedic, homoeopathic and other traditional medical systems in the AFMS. On being asked by Parliament's Standing Committee on Defence a few months ago on the efforts being made to introduce homoeopathy and ayurveda in service hospitals, the Defence Ministry stated that the AFMS have been debating the introduction of Indian system of medicines and homoeopathy in the services since 1956. "These systems have not been introduced at a large scale due to the specific role of the AFMS to support the services during war as homoeopathy and ayurveda systems do not cater to war-time requirements," the Ministry's reply stated. "However, efforts are being made to introduce these systems for the families and population living in civil areas by opening up facilities in cantonment general hospitals," the Ministry added. Extensive research is also being undertaken by the Defence Research and Development Organisaton (DRDO) on various herbal medicines and remedies without heavy metal or chemical content for introduction into the Armed Forces. Several DRDO laboratories are engaged in cultivation and preservation of medicinal and aromatic plants and herbs and several herbal products and remedies have been developed by them. It is also engaged in research on using extract of the aloe vera succulent for frostbite treatment. Stating that the services were working out ways to introduce alternate systems of medicine, the Director General, AFMS, while deposing before the committee, said, "The problem is coming up only in the mixing up of the systems. Now we have taken a decision that alternative medicine will be given a separate place and they will be allowed to develop with the help of the Indian Council of Medical Research and the DRDO. We are going to do the follow-up." The committee said that Indian systems like ayruveda, unani, and sidha were proven systems and were being practised since ancient times, while homeopathy was being used worldwide. Though they may not cater to war-time requirements, these systems were very effective in some areas and service personnel had great faith in them. The committee recommended that the government examine the feasibility of introducing the Indian system of medicine and homoeopathy in various hospitals along with the allopathic system for service personnel.