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EDITORIALS: S Ramasundaram Can India avoid being devastated by HIV? BMJ 2002; 324: 182-183 [Full text]

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Care and Prevention are Inseparable

Chettikulam,N Deivanayagam.   (27 January 2002)

INDIANS CLOSED TO THE SEX ISSUE

Dr Rita Pal   (28 January 2002)

Timely Advocacy

PANCHAPAKESAN SUBRAMANIYAM   (28 January 2002)

Implications of the Indian HIV problem

Parameswaran Hari, Challa Ajit, Anantha Harijith   (9 February 2002)

Need for a holistic approach

Malikkamadom Rajan   (22 February 2002)

Sex education among school students

Sanjoy K Pal   (29 May 2002)

Care and Prevention are Inseparable 27 January 2002
Chettikulam,N Deivanayagam., WHO National Consultant.India Chennai 600 017 Send response to journal: Re: Care and Prevention are Inseparable	Sir, Ramasundaram has neatly described the HIV/AIDS scenario in India.There is a widespread Public perception that the authorities and other health care providers have no policy on providing care to those already infected.Senegal,Uganda and Thailand are achieving results on account of many efforts-political commitment,culture of open debate,involvement of families and reasonable access to care.The editorial omits the experience of Brazil where anti-retrovirals are available to those who need them . Indian Pharmaceutical Industry is dynamic and is able to supply antiretrovirals to Brazil,Nigeria and South Africa.The authorities should negotiate with the Indian Pharmaceutical Manufacturers and make life saving drugs available to the needy.This is a moral and ethical duty. The editorial has failed to mention the efforts of Siddha,Ayurveda and Other traditional practitioners in controlling HIV/AIDS.Siddha drugs have induced a fall in viral load and enhanced CD4 cell counts(Evaluation of Siddha Medicare in HIV Disease.C.N.Deivanayagam et al Journal of Association of Physicians of India 2001;49:390-1). Let us undertake a Public Discourse on approaches to this epidemic which is fifteen years old in India.We cannot separate care and prevention,nay,we should not. Sincerely Dr.C.N.Deivanayagam.
INDIANS CLOSED TO THE SEX ISSUE 28 January 2002
Dr Rita Pal Send response to journal: Re: INDIANS CLOSED TO THE SEX ISSUE	Most people wonder why AID/HIV is worsening in India. A number of interventions occur and the government tries its best to cope. Having worked in India albeit for a short time, I experienced the side that noone talks about. India as a nation is culturally trapped in London's Victorian Era with respect to attitudes towards sex. If sex, transmission of diseases and safe sex is taboo then no amount of intervention will improve the problem. I worked in Calcutta and witnessed that prostitution is rife in many areas. These areas had a high incidence of AIDS. The media hides this. The Media in India hides everything with respect to sex. Everything surrounds sickly Bombay movies where pretty girls run around into their lovers arms with a Asha Bosle song playing in the backgound. A dreamworld where the camera is "cut" where the couples kiss! I say this because the population of India can be reached by the Bollywood powers but this means has not even been considered. Reaching people with small education health intervention is impossible. For a start people would probably never believe it nor would they attend. When it comes to sex on screen or even featuring important matters like condoms, this is rarely seen. India is the land of the Karma Sutra. Sexual experimentation is rife in all areas. Its simply that warnings of the dangers are ignored due to the backward attitude that sex should be kept behind closed doors. Hypocrisy is the worst enemy of India. Facades are a great evil for those who place themselves in danger everyday. The Indian media fails to educate people due to the attitude that " sex must never be seen to happen". Quite frankly it does despite various protests. If it didnt then there then it is hardly believable that the entire population originates from the stork!! That is ofcourse what Indians would like their younger generation to believe! Until India as a nation alter their attitudes to safe sex to even bring themselves to publicise condoms on a regular basis, AIDS will continue to rise to uncontrollable levels. Its a simple concept - if you cannot reach your population then you cannot prevent a behaviour that results in the spread of HIV. India loves to be behind closed doors until ofcourse they find their own children dying of the disease. Only then will they do something about their hypocrisy. But by then it maybe too late! Kind Regards Dr Rita Pal Editor www.nhs-exposed.com
Timely Advocacy 28 January 2002
PANCHAPAKESAN SUBRAMANIYAM, Director, Centre for Development Research and Training (CFDRT) CHENNAI, INDIA, 600 017. Send response to journal: Re: Timely Advocacy	The editorial is very informative, useful, evidence-based and is in the nature of timely advocacy urging the immediate upscaling of the efforts for the control of the transmission of HIV infection in India. Will be useful for not only those who are in direct charge of such efforts, but also for the general public, health researchers and students of public health.
Implications of the Indian HIV problem 9 February 2002
Parameswaran Hari, Jefferson Health System Lankenau Hospital, Philadelphia, PA 19096, USA, Challa Ajit, Anantha Harijith Send response to journal: Re: Implications of the Indian HIV problem	Ramasundaram (BMJ 2002; 324: 182-183)in his editorial has rightly addressed heterosexual intercourse as the prime target of HIV prevention efforts in India. However we feel that spread through the blood product network, needle stick route and mother to child transmission are also important modes of HIV transmission in India. In a country where blood donations generally originate from directed donors or paid donors , the scope for HIV spread through the blood bank system is huge. Total dependence on a system of repeat voluntary donors with scrupulous testing and regulation of blood banks is the ideal solution (ref.1). The resouce and logistic implications of building such a system is enormous. Notwithstanding the legislative effort already underway in India, the final success requires a system of accreditation of the blood banks and public education to avoid unlicensed blood providers. Another area of concern is the vast numbers of private medical "clinics" especially in rural areas staffed by undertrained nursing personnel (ref.2). Coupled with poor resources and the wide spread practice of resterilising needles, this system of clinics is in urgent need of regulation. Complete abstinence from breast feeding is the safest way of avoiding mother to child transmission of HIV. However most Indian mothers are unaware of their HIV status and breast milk the easiest and most nutritious infant feed they can provide to their infants. Women's education and compulsory prenatal HIV testing coupled with ensuring universal medical coverage in prenatal period is the expensive solution. India is a society at war with its own beliefs and traditions. Gender inequality, economic discrimination and illiteracy are rife. HIV will decimate India if its society fails to appreciate the need and urgency for change in the societywide context within which risk occurs. 1. Nanu A. Blood transfusion services: organization is integral to safety. Natl Med J India 2001 Jul-Aug;14(4):237-40 2. Anand K, Pandav CS, Kapoor SK. Injection use in a village in north India. Natl Med J India 2001 May-Jun;14(3):143-4 3. Brown H, Vallabhaneni S, Solomon S et al. Attitudes towards prenatal HIV testing and treatment among pregnant women in southern India. Int J STD AIDS 2001 Jun;12(6):390-4
Need for a holistic approach 22 February 2002
Malikkamadom Rajan, Secretary, Health India Foundation Chennai 600004 Send response to journal: Re: Need for a holistic approach	Mr. Ramasundaram makes a strong plea for prevention to control the spread of HIV/AIDS. Aparently he believes that the adage prevention is better than cure needs to be taken a step further. Prevention alone has not worked in other infectious diseases unless it is taken up as a global campaign, for example small pox or polio (which is still ongoing). No infectitious disease could be controlled by prevention alone. Thus, cure must be an integral part of all attempts to control HIV/AIDS. As Dr. Deivanayagam stated there are tested approaches towards better cure and care for HIV/AIDS patients. The experiment in Brazil is just one. Practtioners of traditional medicine in India have shows some success in arresting the spread of HIV infection in some patients. These efforts need to be further strengthened. Both the Government and the medical profession must support these efforts.
Sex education among school students 29 May 2002
Sanjoy K Pal, Rearch Associate Dept. of Gastroenterology, Sanjay Gandhi PG Institute of Medical Sciences, Lucknow 226014, India Send response to journal: Re: Sex education among school students	While presenting the AIDS scenario Ramasundram1 have highlighted many obstacles to HIV prevention campaign. Sex is a taboo subject in India. Sex education is imparted when students of our country reach class 9 or 10. The World Health Organization has termed the age group 10 –19 years as adolescence. In that case sex education should start from class 5. However, we have not been able to decide what is the right age for sex education. There are problems that the Government faces in implementing its policies. The Government has always softened its stand by calling such programs ‘Population explosion & Family planning’. It cannot be called as education as it might hurt the sentiments of people. According to a recent survey, 2 a quarter to a third of the Indian’s young people indulged in premarital sex, which varied from 17% among school children to 33% among young workers in a north Indian population. About a third of the responder was found lacking in any kind of awareness about unsafe sexual encounters. In another survey, 3 school students from sixth standard onwards posted as many as 120 questions anonymously related to sex. At present there is no cure for HIV/AIDS, primary education about human behaviour and sexuality is appropriate for the child development as an individual. If young minds are kept in dark, it can prove to be disastrous. A child should be brought up in a curriculum that he/she gets accurate information about sex from teachers, parents as well as from the society. It is a de-facto that children get to know about sex from unreliable sources and ill-informed classmates. Sex education should be made an integral part of school course curriculum and taken up seriously. Critics are however concerned that introducing sex education in school curriculum might bring in perverted ideas in the minds of children and lead them to an untoward thought process, but on the contrary they would get the right stuff, at the right time from the right source. So it is almost imperative that at the correct age, children should be provided with interactive sex education in school. HIV/AIDS is now more than a spreading health problem, it has begun to pose a grave economic and social challenges to the world. Our effort should be on prevention, reaching out to all section of the population. Proper sex education at an appropriate time to vulnerable target group like young students can bring about a healthy change in behaviour and ideas about safe sex. This approach is one way out, which can help in countering the rising problem of HIV in our country. Proper knowledge dissemination can only save us from HIV disaster. References: 1. Ramasundram S. Can India avoid being devasted by HIV? BMJ 2002; 324: 182 –183. 2. Sharma R. More than a quarter of India’s youngsters have premarital sex. BMJ 2001; 322: 575. 3. Vaidya A. AIDS in India: doctors report new trends. The Times of India. February 4 2000.