Re: Let's not stigmatize HIV+ women with HIV- husbands

[Guest guest]

Dear FORUM,

I am glad and Mariette have flagged of this issue.

Re: /message/8114

I have personally been positive for the last 4 years. My husband and two

children are negative and it really hurts when you see the judgemental attitudes

of people and health care providers.

It all began when I started falling ill regularly after 2 years of my 2nd

delivery, and was detected positive, My husband and my kids were tested negative

to my relief . And as you have clearly mentioned the only disreputable thing I

have done is accessing services of a dentist for root canaling and 2 deliveries

at private antenatal clinics.

Fortunately my parents and husband have been very supportive. But my heart goes

out to those women who have to face double stigma and the judgemental attitudes

of society when she is detected positive and her husband negative for probably

no fault of hers.

I do agree with you that there is a lot to be done, and many other stories like

mine can be classic cases of negligence at clinics where we women may have

accessed clinical services.

Thanks

Jaya Nair

Projects Manager

Udaan Trust

e-mail: udaantrust@...

[Guest guest]

Dear All

Re: /message/8114

The Times of India news item on estranged women testing HIV+ was interesting to

read for several reasons. There is an overall impression I gather from the news

item that women must also take the “blame” for promiscuous behavior.

The so called HVI/AIDS experts seem to feel that unlike in the past men alone

cannot be blamed for their promiscuous behavior fuelling the HIV epidemic in

India. The question that comes to my mind is, “So who are these women having sex

with?” And if in the past men were held

responsible for fuelling the epidemic through promiscuous behavior, who were

they having sex with?

So we go to town armed with statistics gathered from a couple of government

hospitals on discordant couples and happily draw conclusions as if HIV is spread

only through the unsafe sex route and if a “wife” is positive while the husband

is not, she must be sleeping around!

Since the stats are from State run hospitals of Hyderabad we can use this as a

good social indicator! Sounds very much like an open and

shut case against wives, doesn’t it? See, the ratio of men/women living with HIV

has tilted in favor of men as women who are HIV positive while the husbands are

negative being on the rise.

The news item further implies that we cannot push the data under the carpet

anymore that wives are sleeping around. What if wives cite blood transfusion as

the reason?

Why should we believe them anyway?!

It helps us enormously as we do not have to expend time and energy looking at

our blood safety programs; especially in the private sector.

Even if we know most of the housewives from middle and upper middle class access

only private healthcare setting. We are ecstatic that the percentage of men was

90 among couples who approached the doctors and it has fallen to 65 now. “It may

have dropped further” muses a

doctor, seriously implicating wives.

HIV/AIDS experts must be fully aware why gender issues play a pivotal role in

HIV prevention strategy and it is an irresponsible news item like this that can

play havoc in the lives of the wives living with HIV and deny them access to

familial care and support.

If the news item says the “trend has been there for sometime now” and it cuts

across all classes of people including urban/rural then what is “news” there

that needed publication?

Even if wives have become more promiscuous than before, what really is the

issue? That women are breaking stereotypical roles?

Looks like the societal expectation of women's behavior allows the society to

surprise itself when women break out of stereotypes.

Tch Tch Tch. Can we please grow up?

Regards

Sreeram

Sreeram Varadadesikan

e-mail: <setlurs01@...>

________________________________________________________________________________\

____

Never miss a thing. Make your home page.

http://www./r/hs

[Guest guest]

Dear all,

Re: /message/8114

It seems that all concerned are missing the point.Everyone is trying to push

ones own agenda.

, as usual, wants to make a case against sexual transmission and for

parenteral route of transmission. Others talking against stigmatization of HIV+

women in discordant settings.Etc.

We know that: Safe injection and medical treatment is and should be a

top priority irrespective of whether whatever is the major mode of

transmission of HIV in India.

We need further exploration of the modes of transmission of HIV (and

other diseases transmitted through unsafe injection practices.)

In our opinion the current epidemiological pattern shows that majority of

transmission is occuring in high risk situations (the age

distribution, the gender distribution, the emerging pattern of new

infections, etc.) Even the NFHS III data quoted by et al are

still not sufficent to disapprove the current thinking.

As reagrds stigma, STIGMA OF ANY KIND TOWARDS ANY PERSON IS EQUALLY

BAD. And, unfortunately, stigma is a reality in current Indian

scenario.

The article quoted by is in bad taste and irresponsible because it

" stigmatizes " and not because it stigmatizes a particular subset of women who

have acquired HIV, may be due to some behavior that has been or is becoming more

common in the society and their spouses are HIV negative.

The attitude suggests that men taking risks in sex life (and women)

are worth stigmatizing.

Dr. Vinay Kulkarni

PRAYAS Health Group

e-mail: <vinsanms@...>

[Guest guest]

Dear friends,

I agree with Mr. Vinay when he says that the article in 'Times of India' is in

bad taste and irresponsible because it " stigmatizes " . On top of it, I will like

to add that this article uses very wrong way of interpreting results.

Friends, I am quoting a few paragraphs from the NFHS III final reports. Please

go through it. I also request you to go through the table 12.10 quoted in the

article and interpret this table yourself. I think, this kind of irresponsible

journalism should not be allowed in a national paper of a sort of 'Times of

India'.

Here are the paragraphs from the report:

" All women age 15-49 and men age 15-54 in households selected for the NFHS-3 HIV

sample were eligible for HIV testing. For over 27,000 married couples, both the

husband and the wife agreed to be tested for HIV in NFHS-3. Results shown in

Table 12.10 indicate that both partners were HIV negative for 99.50 percent of

couples and 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.

The variation in the level of couple HIV infection by background characteristics

generally conforms to the patterns observed with respect to the variation in

individual seroprevalence rates. In addition, there are notable differences in

HIV prevalence according to the relative ages of the marital partners. HIV

positivity for both partners is highest when the

man is 15 or more years older than his wife. Discordant cases are highest when

the man is 10-14 years older than his wife. HIV prevalence overall is lowest

when the woman is older than her husband.

" A similar pattern of discordance is seen for the high HIV prevalence states in

Table 12.11. In each of these states, when there is discordance, the man is much

more likely than the woman to be HIV positive. In the five high HIV prevalence

states combined, men are almost six times as likely to be HIV positive as women

when the couple has discordant results. About 1 percent of all married couples

in Manipur, Karnataka, and Andhra Pradesh have discordant HIV results. Manipur

has the highest percentage of couples in which both marital partners are HIV

positive ( 0.62 percent) and the highest percentage in which at least one of the

marital partners is HIV positive (1.61 percent). "

I do not want to add any statement from my side. And, request you to go to

download the report from the link

http://www.nfhsindia.org/NFHS-3%20Data/VOL-1/National%20Family%20Health%20Survey\

%202005-06%20India%20Report%20-%20Volume%20I%20(6823K).pdf

and see the table 12.10.

I feel sorry, if this mail goes further ahead to create more stigma against a

group of people. I do not mean that.

Regards,

Subodh

Subodh Gupta <subodh.acad@...>

[Guest guest]

Dear Moderator,

Re: /message/8114

I think Mrs Nair's unfortunate personal experiences regards acquiring the virus

through routes other than sexual, drive home the point and Mariette have

been making for some time about the larger role of parenteral transmission than

held by most epidemiologists at present .

May I request or Mariette to please post a complete bibliography of

publications that provide evidence in favour of parenteral transmission ?

Deepak

Deepak Batura

e-mail: <d_batura@...>

[Guest guest]

Dear FORUM,

Thanks to Deepak, in bringing attention to this issue. In response to his

request

(/message/8134)

Here is a list of references that provide evidence for HIV transmission through

blood exposures in India.

1) Model-based estimates of HIV from medical injections:

Hauri AM, Armstrong GL, Hutin YJF. The global burden of disease attributable to

contaminated injections given in health care settings. Int J STD AIDS 2004; 15:

7-16.

Singhal T. Burden of HIV in India due to unsafe injections and blood

transfusions. MSc thesis submitted to University of London, 2002.

2) Studies showing blood exposures in India (other than injection drug use and

transfusions) as risks for prevalent or incident HIV infections: We are aware of

5 studies:

SS, Pulimi S, Rodriquez II, et al. Dried blood spots are an acceptable

and useful HIV surveillance tool in a remote developing world setting. Int J STD

AIDS 2000; 15: 658-661.

Chattopadhya D, Riley LW, Kumari S. Behavioural risk factors for acquisition of

HIV infection and knowledge about AIDS among male professional blood donors in

Delhi. Bull WHO 1991; 69: 319-323.

Becker ML, Reza- S, Ramesh BM, Washington R, Moses S, Blanchard JF.

Association between medical injections and HIV infection in a community-based

study in India. AIDS 2005; 19: 1334-1336. (This is

from the India-Canada Collaborative HIV/AIDS Project

[iCHAP] in Karnataka.).

Reynolds SJ, Risbud AR, Shepherd ME, et al. Recent herpes simplex virus type 2

infection and the risk of human immunodeficiency virus type 1 acquisition in

India. J Infect Dis 2003; 187: 1513-1521;

Mehendale SM, Shepherd ME, Divekar AD, et al. Evidence for high prevalence &

rapid transmission of HIV among individuals attending STD clinics in Pune,

India. Indian J Med Res 1996; 104: 327-335. (Both of these reports are from a

study among STD patients in Pune.)

Panda S, Kumar MS, Lokabiraman S, et al. Risk factors for HIV infection in

injection drug users and evidence for onward transmission of HIV to their sexual

partners in Chennai, India. J Acquir Immune Defic Syndr 2005; 39: 9-15.

3) Many published studies as well as unpublished information describe nosocomial

and unexplained HIV infections in India, for example:

Singhal T. Burden of HIV in India due to unsafe injections and blood

transfusions. MSc thesis submitted to University of London, 2002.

Singh S, Dwivedi SN, Sood R, Wali JP. Hepatitis B, C and human immunodeficiency

virus infections in multiply-injected kala-azar patients in Delhi. Scand J

Infect Dis 2000; 32: 3-6.

Banerjee K, Rodrigues J, Israel Z, Kulkarni S, Thakar M. Outbreak of HIV

seropositivity among commercial plasma donors in Pune, India. Lancet 1989; ii:

166.

Singh S. Human immunodeficiency virus transmitted through sheep brain

anti-rabies vaccination. Vaccine 2003; 21: 4119.

Madhivanan P, Mothi SN, Kumarasamy N, et al. Clinical manifestations of HIV

infected children. Ind J Ped 2003; 70: 615-620.

MC, Gopalkrishnan G, Kumarasamy N, et al. HIV in couples in South India;

implications for prevention. Int J STD AIDS 2005; 16: 442-445.

Christiansen CB, Nielsen C, Machucca R. Cluster of HIV-1 infection among

children in Indian Hospital in Bombay. Informal report to World Health

Organization, September 1998. Department of Virology, Statens Serum Institute,

Copenhagen, Denmark, 1998.

These reference illustrates the lack of seriousness with which we in India have

taken this issue. The reference reports that 8 infants in a

Mumbai orphanage seroconverted during 1996-97.

Sequencing of HIV from 6 pointed to a linked outbreak. HIV transmission to these

children is suspected to have occurred during October 1996 treatment in a Mumbai

nursing home. Three children had received blood or blood products; for the

remaining 5, the reported

risks are “intravenous antibiotic treatment and routine immunization.

In countries like Romania, Russia, Poland and Kazakhstan, with fewer cases of

unexplained infections, investigations were carried out which led to unearthing

of large outbreaks, and the subsequent cleaning up of health care systems. In

the India case, as far as we are aware, absolutely nothing was done.

The only reason this was discovered was that the children were to be adopted in

Denmark.

And these are not isolated cases. During the course of our research and other

work in India, we have come across many unexplained cases (children with

HIV-negative mothers, adults with no known 'risky'

behaviours) These cases are not even reflected in our national data, leave alone

investigated.

You could also get a film on this issue, " Unheard Voices " from TISS, Mumbai.

Contact Anjali Monteiro at umctiss@...

For those who are interested in the contribution of blood exposures to

Africa’s HIV epidemics, here are two references that give opposing views, and

that provide an introduction to the ongoing debate:

Schmid et al. Transmission of HIV-1 infection in sub-Saharan Africa and effect

of elimination of unsafe injections. Lancet 2004; 363: 482-488.

Gisselquist et al. Let it be sexual: how health care transmission of AIDS in

Africa was ignored. Available at:

www.cirp.org/library/disease/HIV/gisselquist1/gisselquist1.pdf

With regards,

Mariette Correa

Gisselquist

--

Mariette Correa

1016, Muddo

P.O. Carona

Bardez, Goa - 403523

India

Tel: 91-832-2293766

email: mariettec@...