Transcript HIV / AIDS EPIDEMIC IN INDIA Lt Col HS Ratti, MD (PSM), DNB

HIV / AIDS
EPIDEMIC
IN
INDIA
Lt Col HS Ratti, MD (PSM), DNB
1
HIV/AIDS Global Pandemic: End 2002
Number of people living with HIV/AIDS
People newly infected with HIV in 2002
AIDS deaths in 2002
First Cluster
70
42 million
5 million
3.1 million
4.57 m
5%
1992 1.7 m cases
95% infections in developing countries
20% infections in SE Asia mostly from India
16,000 new HIV infections a day
HIV EPIDEMIC: 1986 - 2002
1986
First case of HIV
detected in
Chennai
1990
1994
HIV Prevalence
reaches over 5%
amongst high risk
group in Maharashtra
and Manipur
1.74 m infected
4.58 m. Indians living with HIV
1998
3.5 m. infected
> 1 % antenatal women
2001
3.97 m. infected
> 5 % high risk groups
2002
4.58 m. infected
< 5 % high risk groups
HIV Estimates: India
No. estimated as HIV infected
(in millions)
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
1981
1990
1994
1998
1999
2000
2001
2003
Modes of Transmission
3.36
3.27
2.14
6.7
84.53
Sexual
IDUs
Blood and Blood Products
Perinatal
Unidentified
Proportion of HIV sub-types in India
Others A
3%
3%
C
91%
B
3%
Northern India
HIV subtypes in
regions of India
Eastern India
C
A
B
Others
D
E
Thai B
Western India
Southern India
Modes of Transmission of HIV
• Blood
• Sexual Activities
• Mother to child
Probable Sources of Transmission
in AIDS Cases in India
3.36 3.27
2.14
6.7
84.53
Sexual
IDUs
Blood and Blood Products
Perinatal
Not Known
DYNAMICS OF HIV TRANSMISSION
Risk Group
Population
General
Population
General
Population
Bridging
Population
B.S.S. - 2001
Knowledge on Modes of Prevention
HIV/AIDS can be prevented by:
Urban
Mean
Rural
Mean
Total
Weighted
Low awareness
High awareness
( Rural Female)
(Urban Female)
M
F
M
F
Consistent
condom use
83
64
66
43
59
Bih-12; Guj-13;
W Bengal-14
Mpur-88; HP-88;
Sikkim-83
Having 1 faithful
uninfected
partner
72
65
60
48
57
Bih-14; Asm-15;
W Bengal-19
J&K-90; HP-88;
Manipur-84
Aware of both
the above
means
66
51
52
34
47
WBen-8.3;
Ori-10; Bih-10
HP-81; J&K-78;
Manipur-77
Sexual
abstinence
89
80
75
60
71
Bih-20; Guj-21;
UP- 24
Mpur-96; HP-94;
Kerala - 93
Figures in percentage
Base = all respondents
Reported Non Regular
Sex Partners
14
12
10
8
Male
Female
Both sex
6
4
2
0
Urban
Rural
Combined
Overall - 6.6 %
Condom use in last sex with
non-regular partner
70
60
50
Male
Female
Both sex
40
30
20
10
0
Urban
Rural
Combined
Overall- 49.3 %
Factors that make India vulnerable
• Organised commercial sex & casual sex with
non-regular sex partners
• Migration & cross-border movement
• Approx.100 million people migrate per year
– Rural to urban migration
– Inter-State migration
• Sociocultural beliefs & practices
• 26.1% below poverty line
• 65% literate
– Males
:
75.8%
– Females :
54.2%
• High Prevalence of RTIs / STDs
17
Determinants of Transmission
From an Infected Person
•
•
•
•
•
Duration of infection/stage of disease
Risk of transmission per sexual act
Presence/absence of concurrent STD infection
Condom use
Partner exchange rate
- Mixing pattern
-
Concurrent partners vs. serial monogamy
Patterns of sexual behaviour
Factors Promoting Sexual
Transmission
• Rate of partner exchange
• Multiple concurrent partners vs.
serial monogamy
• Sexual mixing patterns
• Sexual practices(vaginal, anal. Etc.)
• Condom use
• Willingness to reduce partners/
delay intercourse
Intervention Issues for India
• Effective surveillance (geographic, risk
group and HIV subtype)
• Reduction of stigmatization
• Prevention of transmission from risk groups
• Prevention of transmission from husbands
to wives
• Appropriate strategies for prevention of
transmission from mother to infant
-
Infrastructure for identifying and treating
HIV infected pregnant women
Treating the infant during peripartum and
nursing
Cont…
Strategies to Prevent HIV
Infection and AIDS
• Blood
-
Reduce use of whole blood
Screening of blood donors
Screening of blood donation
Processing of blood products
Institutionalization of routine safety
procedures for health workers and
biomedical laboratory technicians
Cont…
• Commercial Sex workers
-
Education on risk activities
Use of condoms
Persuasion of brothel owners/
managers
- Regular screening and effective
treatment for STDs
- Regular testing for HIV
- Legalization and regulation of sex
workers
Cont…
• Injecting Drug Users
-
-
Reduce needle sharing
Use of bleach or boiling
Needle exchange programs
Methadone clinics
Health education/behavioural
intervention for intravenous drug
users
Improve access to testing
Cont…
• Mother to infant
-
Screening of women in high-risk groups
Pre-pregnancy testing
Routine screening of pregnant women
Counseling and abortion
Antiretroviral treatment –prenatal
PCR/isolation/IgA screening of infants
Post-natal treatment, including during breast
feeding
Education
Breast feeding only if no access to clean
formula
Screening and effective treatment of STDs
Cont…