The revised HIV estimates: Impact on Policy & Programmes:

[Guest guest]

Dear Forum,

The question being projected now again and again is what change the new

projected estimate will result in the program planning and implementation. The

Authorities have mentioned there is no reason for any drastic change in the

program. And generally everybody accepts that. But I feel it need not be always

the best policy.

This should be an eye opener to start collecting more data and plan corrections

in our programs. As I suggested during NACP 3 program we need to ready for a

living program than a rigid and non living program which is amenable to the

newly acquiring knowledge.

For example the STD control program in India depends on various assumptions (if

there are any) which are not really checked or tested. The STD specialists of

south India are of the opinion that there is a major shift in the STDS from

ulcerative to non ulcerative and bacterial to viral. Is spending money on a low

level epidemic of non ulcerative STD going to have any impact on HIV epidemic?

To start answering this kind of questions we should have scientific studies in

this area and many of think studies like this will lead to revision of

strategies and programs.

This kind of program revision is essential in other areas also especially in

ART where newer and newer therapeutic strategies are being implemented like once

a day combination therapies, saliva testing for diagnosis, better medicines for

OIs , etc.

I request all concerned to consider this as an eye opener to start more relevant

research in areas which can make changes and keep the program and strategy

flexible.

Dr Ajithkumar

e-mail: <ajisudha@...>

[Guest guest]

Dear Forum,

I am totally agreed with Dr. AjithKumar opinion. We need to start

more data specially among vulnerable groups (people with STIs, MSM,

IDUs, CSWs) and revised and corrected plan for programs regarding

this group.

For instance in case of STIs research shows that HIV infection is

greatly associated with both ulcerative and non ulcerative STIs

Lesion, inflammation or any other damage caused by STI does

facilitate the transmission of the HIV virus ranging from 2 % to 7%

during sexual intercourse. Genital discharge due to non-ulcerative

STIs) contains cells expressing molecules to which HIV can attach,

such as CD4 and chemokine receptor (CCR5) making these patients more

susceptible to HIV infection. Compared to patients without these

diseases, non-ulcerative STIs may facilitate HIV acquisition by

recruiting HIV target cells to the endocervix.

At present, there are no fully functioning STI surveillance systems

operating in India. STI reporting is affected by its natural

history (a large number of infections are asymptomatic) and the

social stigma in India. Only part of the symptomatic population

seeks health care and even a smaller number of cases are reported

due to stigma associated with STIs.

However, if we do not able to overcome all these resistance to

collect proper and accurate data there will be no benefit from

program planning and implementation among this group. In my personal

opinion (it is true that millions of people affected with HIV

whatever our national estimate we have got now) we need more

research how to reach effectively to vulnerable groups, (especially

IDUs, people with STIs; they are interrelated also; more people with

IDUs more risk of STIs; more risk of HIV) collect data and on the

light of it effective interventions to prevent growing epidemic of

HIV in India.

Dr.Lipi Dhar MBBS. DFw & CH (Delhi)PG Dip in PH(Aus,Distinction)MPH(Aus)

E mail: drlipidhar@...