Who should be hanged for Infecting 18,000 Children with HIV, a failed PMTCT

[Guest guest]

PEOPLES HEALTH ORGANISATION (INDIA)

Municipal School Bldg., J J Hospital Compound, , Mumbai- 400008

Tel: 23061616; Fax: 23000016; 9820081566; E-mail: ihoaids@...;

gilada@...

Press Release: AIDS Number game/ November 26, 2010

UNAIDS BEATING RETREAT BRINGS GOOD NEWS for INDIA on AIDS FRONT:

But who should be hanged for Infecting 18,000 Children with HIV, a failed PMTCT?

UNAIDS estimates released on 23rd November as a ritualistic prelude to the World

AIDS Day, show that the number of cases in India is changed marginally and it

has done well in stemming the epidemic.

The world will observe the World AIDS Day on Dec.1 with the theme “Universal

Access and Human Rights’. Ironically, though there are some activists to protect

trees and animals, and few for human rights, there is a severe shortage of

'Child Right Activists'.

The foetus continues to be neglected, as it doesn’t even cry. That’s the sole

reason the super-power India, the world leader in Pharma and IT sector has

miserably failed in prevention of parent to child HIV transmission (PPTCT)

programme.

Admittedly, the National AIDS Control Organisation (NACO) says India recorded

18,000 children getting HIV from 65,000 HIV+ mothers in 2009, where as there are

strategies to prevent most of them, if not all.

Shamefully a meager 10% of the pregnant women are covered under PPTCT and the

HIV+ women received only single-dose nevirapine, a strategy meant for Africa.

Who should be held responsible and hanged for this gross neglect? India is still

grappling under an unusually prolonged HIV number-game coupled with

unprecedented challenges, several unwanted controversies, diversified attention

and inadequate responses to the Epidemic, thanks to running our official

programmes on clutches of external donors.

Our AIDS programme is being destroyed by 'opportunists' akin to the HIV patients

ravaged by opportunistic infections.

Peoples Health Organisation (India) – PHO; has been the first NGO to have raised

an alarm against AIDS in 1985 and fore-warned in 1990 about the crisis in the

offing.

The initial phase of generalized ignorance of the seriousness of the epidemic

and complacency termed as the ‘blame-game’ did earn India a dubious distinction

of being the world’s HIV capital in 2006 though now slipping it into the third

position in last 3 years in an orchestrated ‘number-game’.

Without getting into jugglery of statistics let us gracefully accept a stark

reality, that HIV is widespread, touched every corner of India without

distinction of caste, creed and socio-economic status, with a saving grace - the

HIV rate is on decline in last 4 years.

Apathy and lack of political will lead to a poor national programme in early

days making HIV/AIDS a Man-made, Politically Neglected and Socially Sponsored

calamity.

Unfortunately neither National AIDS Control Program (NACP) has changed, nor the

attitude of its officials, which is seen in regressive stand in monopolizing HIV

treatment at Govt. run ART centres.

The Health Ministry and NACO is jubilant that the spread of the deadly disease

was well under control in India, with the UNAIDS endorsing its current

low-estimates. It showed the HIV prevalence dipping to 0.31% (men 0.36%,women

0.25%) from 0.36% in 2006, 0.45 in 2002 and 0.9% earlier.

UNAIDS has termed India as the third worst HIV-affected country after South

Africa (5.5 million) and Nigeria (2.9 million).

How can one compare India to a nation less than the size of one of her states

and a 30 times more HIV prevalence? India can never be ‘Africa’ vis-à-vis HIV

and even at highest peak in a worst case scenario, HIV prevalence it will not

cross 2%.

There has been a decline in HIV cases in the states of Tamil Nadu, Maharashtra

and Karnataka, while it has increased in Punjab, Orissa, West Bengal and

Rajasthan.

Mahrashtra and Tamil Nadu which were worst affected states a decade ago have

slipped to 6th and 10th positions respectively.

Nationally HIV ranking among its states from 1 to 10 is: Manipur, Andhra

Pradesh, Mizoram, Nagaland, Karnataka, Maharashtra, Goa, Chandigarh,Gujarat and

Tamil Nadu.

UNAIDS said 33.3 million are now living with HIV, incorporating 2.6 million

people worldwide were infected with HIV, 1.8 million people died from AIDS

related illnesses in 2009.

AIDS is now a chronic problem, like diabetes, hypertension or other viral

infections taking down the careless or weak members of the group. Nothing has

been yet invented that kills this virus.

Suggesting that UNAIDS earlier manipulated data, the National Family Health

Survey (NFHS-III) that changed the face of HIV statistics in India, covered

100,000 subjects in a country of 1.1 billion people in the age group 15-54.

About 280 HIV positive cases were actually detected by the surveyors, bringing

down the prevalence to 0.28% from an earlier presumption of 0.9%.

This, when broken down further for the 28 states and seven Union territories,

(no HIV tests done in Nagaland which resented the blood collection) results in a

HIV rate in single digits.

Statistically significant results can only be interpreted when the positive

cases are several thousands in number. The sample size should have been at least

four times higher.

Knowing the cultural background of Indians and sex related topics pushed under

the carpet, it is anybody's guess that those with HIV or its risk could have

opted out of the survey.

NFHS is by design a random statistical survey done in the community, meant to

provide signals of what is happening in the larger population, so it

under-represents certain populations.

After the political number game from Bihar elections, this HIV 'number-game'

resulted in wide-ranging reactions, discussions and editorials. NGOs are worried

that with low HIV their funding may dry-up.

According to Professor Levenstein " Statistics are like bikinis; what they

reveal is suggestive, but what they conceal is vital. "

The detailed findings of NFHS-III may reveal if it indeed cover the

vulnerability aspects of people, rather than only looking at HIV rates, as

people are more open to accepting former than the later.

W. Watt says, " Do not put your faith in what statistics say until you

have carefully considered what they do not " .

Way back in 1993, when HIV/AIDS was not much in the limelight, PHO had presented

a paper on 'STD/HIV Risk Mapping' at a Global AIDS Conference, which was based

on the factors related to vulnerability of any town/region and the risk

behaviours of its people - viz. prostitution areas, business / industries,

educational institutions, tourism and pilgrim spots, military bases, highways,

rail stations, airports, ports and alcohol policy.

A fairly accurate risk assessment of any area and country for the STDs/HIV can

be done much before actual surveillance or cases are reported. The forecast can

help in making action-plans and initiating intervention measures.

Two independent studies revealed a disturbing trend that pilgrim centres like

Tirupati, Guruvayoor and Puri changed complexion to become hubs for sex tourism

and children being the most vulnerable.

In developed countries like USA almost 90% of the HIV infections are reported to

as against here in India where only 20% of the infections are recorded at NACO,

due to inherent flaws in the reporting system.

Moreover, half of the infected people do not know their HIV status. Our efforts

to make the risk-takers understand their vulnerability have been inadequate.

Most of the national energy and funds were wastefully spent on 'surveillance'

without 'interventions'.

In response to the impending AIDS crisis, after an unusually prolonged phase of

denial and complacency and blaming others, India started planning and

implementation in the NACP-phase II (1999-2006).

It once again sidetracked ‘interventions’ in NACP III that started in April

2007. What is urgently required is a national level thorough consultation-

involving the stakeholders; long-term players; think tanks to resolve the number

game at once and then follow a commonly derived track. We must honestly accept

that HIV is

widespread.

We should provide subsidized (not free for all, but three-tiered approach) ART

with quality care; move from 'Donor-dependence' to 'Self-reliance'; evaluate

NGOs and replicate best practices; reduce vulnerability of women and children;

PMTCT as an emergency; and focus on youth and de-addiction.

AIDS has always been maddening. The virus moves more slowly than any infective

organisms that ride sneezes or coughs or rats or mosquitoes HIV permits years of

symptom-free infectivity and only kills, like a sluggish-torturer at leisure.

Co-discoverer of HIV, Dr. Gallo, warns a mutation — a virus more easily

transmitted or more drug resistant — could emerge.

Epidemics traditionally move in waves; that could trigger a second epidemic.

Dr. I S Gilada, Hon. Secretary-PHO and crusading against AIDS since 1985 and

Hon. Secretary, AIDS Society of India (A professional body of doctors in HIV

Care)

Dr. I S Gilada,

Consultant in HIV/STDs

Secretary General, AIDS Society of India (ASI)

Unison Medicare & Research Centre,

Maharukh Mansion, Alibhai Premji Marg, Grant Road (E), Mumbai - 400007

Tel +91-22-23061616; Fax: 23000016;

E-mail: gilada@... / ihoaids@...;

Website: www.asicon2010.com / www.aidssocietyofindia.com

[Guest guest]

THE PEOPLE'S PROPHET. Dr. I S GILADA !

Not sure where prophets fit into the scheme of india's religions and social

history.

Almost always a prophet is correct but often ignored until the plague makes

everyone take notice.

Heed this man whose life's work makes him not only a prophet but also an angel

in disguise.

Thank you from an overseas observer who spent many months on the ground in India

confirming exactly what you are saying.

When prevention is possible, well understood and affordable why are so many of

India's next generation being left to die.

GEOFFREY

--

Geoff Heaviside

Convenor - Brimbank Community Initiatives Inc

Convenor - Brimbank International Student Support Services

Secretary - International Centre for Health Equity Inc

Member - Australasian Society for HIV Medicine Inc

P.O. Box 2400 s Lakes 3038

Melbourne . Australia.

Ph: +61 418 328 278

Ph/Fax : (61 3) 9449 1856

Ph: India : 9840 097 178

Ph: Nepal : 9849 174 329

[Guest guest]

Dear Prof. Dongaonkar.

/messages/12299/

I appreciate you comments. Perhaps you will remember that PMTCT programme was

 launched in india after conducting a feasibility study in few medical colleges

in the country.

The results of the study were dicussed with the experts before scaling up the

intervention. If I am not wrong you have also been the part of some of the

meetings.

We should appreciate the efforts of the NACO for expanding the programme up to

the BLock level PHCs/CHCs and gradually being integrated with RCH programme.

Recently I have an oppurtunity to visit some of these centres and it  was

heartening to note that uptake of the HIV Conselling and testing has improved

substantially, in some places over 80%.

Beside prevention of transmission of HIV infection from infected mothers to her

baby, the programme  helps in empowering mothers to avoid infection if found

negative and those who are detected positive provides an oppurtunity for access

to care and support.

we may provide suggestions to NACO and SACS for further Strengthening of the

programme.

Regards.

Dr. P.L. Joshi

Ex Addl Project Director, NACO

e-mail: <doctorjoshi@...>