The Menace of AIDS

Published on September 8, 2009

By Lhingneithem Haokip

The dreaded disease, Acquired Immune Deficiency Syndrome (AIDS), which has swept the world, has hit the Indian shores very badly. The number of registered HIV positive cases is increasing everyday and if the trend continues, India will in coming years top the chart. Presently, India is the third largest population suffering from AIDS, after South Africa and Nigeria.
 
And among the six highest prevalence states of AIDS in India, Manipur and Nagaland are the two states in the list from the North-east. The latest figures in Manipur indicate that 31,972 cases of AIDS are being reported. And out of the nine districts, Imphal Thoubal and churachandpur contribute about 85% of the total number of positive cases. It now stands that, Manipur is one of the highest prevalence of AIDS in India at the rate of 1.57%.
 
Alarm buttons have been pushed the world over to initiate action against the killer disease. But in India, agencies are still quibbling over the number of AIDS patients in the country. The National AIDS control organization (NACO), which is the nodal body for monitoring and carrying out surveillance of the disease, puts the number of AIDS cases in the country at 2.31 million with a prevalence rate of HIV at 0.34%. Although NACO report a state wise HIV prevalence of 17.9% among Injecting Drug Users (IDUs), studies from different areas of the state find prevalence to be as high as 32%.
 
The major carrier of the virus in our country is multiple sex and IDUs. HIV prevalence at antenatal clinics is also higher. The rapid increasing of the disease has indicated that NACO has failed to achieve its aim of spreading awareness and taking preventive steps. The agency has been reduced to issuing late reports on state-wide cumulative occurrence of AIDS cases. Even the figures it turns out are said to be questionable. NACO uses the sentinel surveillance method which leaves a lot to be desired. It reflects only a partial answer.
 
Under sentinel surveillance, a few groups are chosen as markers and the incidence of HIV infection in those is taken as an indication for the whole state. There is nothing wrong with the sentinel surveillance method, in the way it has been designed, but it is not being implemented properly. For the correct picture, a similar group has to be tested every few years so that it can be estimated whether the incidence of injection has gone up or down and a trend established. But it is not done.
 
The organization also does sero-surveillance from all over the state. But these reports are open to incorrect interpretation and are epidemiologically badly designed. The drawback of this method is that it does not define methodology, that is, who is to be tested. For example, at one time, they may decide to test a group of commercial sex workers and the next time, the IDUs. The results are bound to vary drastically as there are no denominators.
Even the World Health Organisation (WHO) officials have stated that the data on AIDS cases and HIV positive patients has no denominator which causes problems in monitoring.
 
In the case of Manipur, officials of Manipur AIDS control society (MACS), put the figure of HIV-positive cases at more than 40,000, saying a large number of cases are unreported. The HIV sero-prevalence among IDUs in Manipur is the highest in the world, which increased from 0 to 50 per cent approximately each year. The sero-prevalence rate among pregnant women is also increasing alarmingly.
 
The undoing of NACO, according to experts, is that it has been given more responsibility than it can handle everything to do with AIDS and its prevention, including funding of the NGOs. With the formation of NACO, the implementation of entire National AIDS control programme (NACP), hitherto under the Director General Health Services, was entrusted to it. NACO was also given the responsibility to carrying out research on AIDS, the sole domain of Indian Council of Medical Research (IMCR). The organization was also supposed to bring about collaborative efforts, among the various agencies.
 
But the problem is that NACO has failed to make up its mind about its role, whether it is simply supposed to be guiding the AIDS Control Proggrammes or controlling them completely. It is essential that NACO decides only to provide the basic guidelines in AIDS control. Though NACO has taken upon itself all AIDS-related activities, the organization has a major human resource constraint. It is still not understood as to how half-a-dozen people sitting in Delhi can effectively monitor what the AIDS cells in the states are doing. 
 
Even one report published in the medical journal stated that, “Unlike developed countries, India lacks the scientific Laboratories, research facilities, equipment and medical personnel to deal with AIDS epidemic. In addition, factors such as cultural taboos against discussion of sexual practices, poor co-ordination between local health authorities and their communities, widespread poverty and malnutrition, and a lack of capacity to test and store blood would severely hinder the ability of the government to control AIDS.”
 
At present, NACO and MACS has various roles at different levels. At the international level, NACO has failed completely in clearing the warped impression about the AIDS situation in India. And in Manipur, MACS does nothing when the state is wrongly called the AIDS capital of the world. A major problem with NACO and MACS is its ineffective information, education and communication (IEC) program me, the mainstay in controlling, the spread of AIDS. The organizations need to adopt a multiple approach, targeting different groups in different ways.
 
However, as everything cannot be left to the government, the involvement of the community is a must in tackling the disease. The other factor which needs to be highlighted is that the surveillance system is very patchy and addresses only high-risk groups like commercial sex workers and drug users. In fact, the surveillance system has to aim at the general public and also remote areas and villages. The problem with AIDS is that it is still considered the ‘other man’s disease’. Things will have to change for the better; otherwise we will meet our doom.
 
The first thing that needs to be addressed is the awareness level of people as far as AIDS is concerned. Counseling through various voluntary and non-governmental organizations is carried out on safe-sex. Affected people should owe more some moral allegiance and stay away from spreading the disease. But this does not mean that they should be socially outcast. If we do not fight the issue in the interest of our society, we will soon be inviting trouble.
 
The writer is a post-graduate student in molecular biology at Punjab University, Patiala, India.