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India's AIDS control programme is unsatisfactory

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6933.877 (Published 02 April 1994) Cite this as: BMJ 1994;308:877
  1. Z Imam

    The number of people found to be HIV positive in India has increased by 25% in the past year, and the number of people with AIDS has nearly doubled. The official figures are that there are 15 000 people who are HIV positive and 559 people with AIDS. But the secretary of the Indian Health Organisation, Dr Gilada, paints a grimmer picture. He says that 2 million people are HIV positive and 100 000 people have AIDS. By 2000 there will, he says, be 30 million to 50 million HIV positive people and 3 million to 5 million people with AIDS.

    The health minister, Mr Shankranand, admitted in parliament last month that the national AIDS control programme was not progressing well. But the 2250m rupees (pounds sterling 50m) that the programme has budgeted for AIDS control for 1992-7 has been underspent by between 14% and 32% in most states. The funds must be used solely for combating AIDS, and India has to give a similar undertaking to the World Bank for the $84m (pounds sterling 56m) that forms part of the total budget.

    Educationalists and health experts are warning that sex education in schools needs to be improved, particularly as India's traditional attitudes towards sex have been eroded by rapid socioeconomic growth. Those who plan the curriculum are conscious of the controversy over whether to introduce the topic of sex and AIDS in schools.

    The problem of HIV infection will continue to grow unless the main routes of transmission - blood transfusion, heterosexual contact, and the use of infected needles by drug users - are tackled. Of 1018 blood banks, only 180 are equipped with facilities for detecting HIV. It has been impossible to check effectively professional blood donors, a common source of HIV infection, because a lot of blood is collected from them and there is already a shortfall of 21 million bottles.

    Truck drivers operating on national highway routes have played an important part in spreading infection. Limited studies have shown that they frequently visit red light districts in Delhi and Bombay. In Delhi alone 50 000 to 60 000 trucks stop at different highway points.

    The incidence of HIV infection varies in different states. In the north eastern states of Manipur, Nagaland, and Mizoram heroin is easily available across the border. The Indian Council of Medical Research reports that 1-2% of the general population in these states are intravenous drug users and about half the users are HIV positive. Out of an estimated 15 000 intravenous drug users in Manipur, a fifth may develop AIDS within the next five years.

    Voluntary organisations are trying to educate the target groups not necessarily to change their lifestyle but to practise safe sex by using condoms. To this end the Ministry of Health and Family Welfare has decided to improve the quality of condoms.

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