Re: Findings of National Family Health Survey (NFHS 3) Report

[Guest guest]

Dear friends,

Re: /message/7942

For those of you who are still convinced that it is almost exclusively

sex that is driving India's HIV epidemic and continue to ignore

evidences that unsafe blood exposures significantly contribute to HIV

spread, the NFHS-III findings provide some food for thought. (Quotes are from

Chapter 12 of the report, which is available at:

http://nfhsindia.org/nfhs3_national_report.html.)

In the popular perception, HIV is linked to poverty as people who are

poor 'do not know about' or 'cannot negotiate' for safe sex. With data

to support its claims, the survey findings state that " There is no

evidence that HIV prevalence is related to poverty in India. In fact,

women and men in households in the next-to-highest wealth quintile are

most likely to be infected with HIV "

" Men who are away from home frequently or for long periods of time are

generally thought to be more exposed to the risk of HIV infection

because they may be more likely to adopt high-risk sexual behaviour when they

are away from home.

In NFHS-3, men were asked how many times they traveled away from their home

community and whether they had been away from their home community for more than

one month at a time in the past 12 months... Contrary to expectations, the men

with the highest HIV prevalence are those that have not slept away from their

home community at all in the past year. There is also no clear relationship

between the

time spent away in the past 12 months and HIV prevalence, since men who have

been away for more than one month at a time have the same HIV

prevalence rate as men who have not been away at all. "

" Women with an STI or symptoms of an STI have a slightly higher HIV

prevalence rate (0.29) than other women (0.26 percent). However,

contrary to expectation, men with a recent STI or STI symptoms have a

lower HIV prevalence than other men. " In fact, the reported prevalence

of STI is much higher in the states which have the lowest HIV

prevalance. (see Chap 11) States with the highest levels of HIV

prevalence have very low reported prevalence of STI.

" For over 27,000 married couples, both the husband and the wife agreed

to be tested for HIV in NFHS-3. Results... indicate that both partners

were HIV positive for 0.11 percent of couples. The remaining 0.39

percent of couples had discordant HIV results, that is, one partner was infected

and the other was not infected. For 82 percent of these

discordant couples, the husband was HIV positive and the wife was HIV

negative. "

These findings underpin the fact that sex cannot explain much of India's

epidemic. This is despite the assumptions of the NFHS III (Chapter 11) which in

its wisdom defines " Comprehensive knowledge on HIV/AIDS as:

1) knowing that both condom use and limiting sex partners to one uninfected

faithful partner are HIV/AIDS prevention methods;

2) being aware that a healthy-looking person can have HIV/AIDS; and

3) rejecting the two most common misconceptions in India that HIV/AIDS can be

transmitted through mosquito bites and by sharing food. "

NO mention of other routes of HIV transmission through unsafe blood

(Mother-to-child transmission is included in a seperate section)

Other data on condom use, number of partners etc can be interpreted in

various ways, depending on the biases of the reader rather than on solid

statistics.

Responses to the findings of this survey would be much appreciated.

Mariette Correa

Gisselquist

e-mail: <mariettec@...>

[Guest guest]

Dear FORUM,

Mariette and have raised some very thought provoking questions indeed.

Re: /message/8011

While we do know of their interest in medical injections and other parenteral

exposures through this site, I would like to look at the questions they have

raised through existing paradigms. In short, if we stick to the sexual route

theory:

Firstly, why is it that people in the next-to-highest wealth quintile are most

likely to be infected with HIV?

Is it because sexual experimentation goes on in all strata of society, and this

group has the financial wherewithal to pay for their pleasures, without being

overly concerned about ensuring safe sex?

Secondly, the assumption that men with multiple partners have been driven to it

because of a long absence from their homes (the poor dears) is a fallacy, as any

one who has seen an STI clinic would safely vouch. Hence, just as it is no

surprise that men who have never left home develop STIs, it is no surprise that

men " who have been away for more than one month at a time have the same HIV

prevalence rate as men who have not been away at all. "

" Women with an STI or symptoms of an STI have a slightly higher HIV prevalence

rate (0.29) than other women (0.26 percent). However,contrary to expectation,

men with a recent STI or STI symptoms have a lower HIV prevalence than other

men. "

If we accept the parenteral route as the significant source, how come there is a

disparity between the genders? This needs explaining. Is it because men fall

sick more often, getting more parenteral exposure or do they have a more

positive health seeking behaviour? Or are we missing a trick here?

Regards the comment: For over 27,000 married couples, ... Results... indicate

that both partners were HIV positive for 0.11 percent of couples. The remaining

0.39 percent of couples had discordant HIV results... For 82 percent of these

discordant couples, the husband was HIV positive and the wife was HIV negative. "

Males have traditionally been more open to experimenting with sex outside the

marital bond . That's what we are seeing here, and also perhaps a lot of women

who are in the incubation period.

I do not mean to disparage the efforts or line of thinking of the authors, nor

do I speak in defence of the survey but merely respond to their request for a

discussion as requested (as a devils advocate if you will).

Sincerely,

Deepak Batura

e-mail: <d_batura@...>

[Guest guest]

Dear Forum,

We would like to continue our discussion on the " Findings of National Family

Health Survey (NFHS 3) Report "

Re: /message/8011

We really appreciate Deepak's response to our posting about the findings of NFHS

III. His interpretation of the findings help to move forward the discussion that

we see is needed to adjust NACO’s HIV prevention programs to new information

from NFHS-3.

Re: /message/8036

If pedestrians are regularly killed at one corner, but the city puts a new

stop-light at another, people would complain. This is the situation we have with

NFHS III vs India’s HIV prevention program.

Currently, India’s HIV prevention program supposes that most HIV is linked to

poverty, migration, sex workers, and STIs. But now, we see from NFHS III that

does not seem to be the case.

Deepak, in his interpretation of NFHS III says that sex risks may be in richer

people who don’t travel.

This response, in effect, avers that India’s efforts for HIV prevention have

been based on thinking something that turns out not to be true. We agree with

him that ideas about India’s HIV epidemic have diverged from reality, but we

think this applies not only to situations for sexual transmission, but also to

non-sexual transmission.

This far into the epidemic, with millions of infections, the NFHS III should be

taken as a wake-up call by AIDS experts. “You’ve been sleeping. You didn’t know

what was happening.”

And now, without presenting any new evidence, are the same experts asking us to

believe another story about how it’s all from sexual transmission, but not the

sexual transmission risks they talked about for 20 years?

If India’s epidemic is to be stopped – if people are to be safe when they go to

the dentist, have sex, get a tattoo, etc -- then more of the same from NACO and

NARI are not good enough.

Let’s trace some HIV infections and get some hard evidence. Where are all these

infections coming from?

Sincerely,

Mariette Correa,

Gisselquist

e-mail: <david_gisselquist@...>