Screening for HIV infection by health professionals in India.

BACKGROUND: Stigma and discrimination, particularly in access to healthcare, remains a major problem for people Infected with HIV in most parts of India. METHODS: We did a multicentre study (n = 10) with a cross-sectional survey design using a standardized, interviewer-administered questionnaire. RESULTS: A total of 2200 healthcare providers participated. The knowledge, attitude and practice (KAP) related to HIV service delivery were very poor with a mean overall KAP score of only 49.7% (CI: 49.1-50.3). Only 5%, 5% and 1% of the participants scored more than 75% separately for the dimensions of knowledge, attitude and practice, respectively. Only 24.4% and 36.7% of responders knew that HIV screening was not recommended prior to surgery and pre-employment check-up. Many doctors (19.4%) had refused treatment to people living with HIV/AIDS (PLHA) at least some of the time and nearly half (47.2%) identified and labelled them; 23.9% isolated them in separate care areas and 13.3% postponed or changed treatment based on the patient's HIV status. Screening for HIV prior to elective surgery was done by 67% of providers. While 64.7% of responders were aware of the existence of national guidelines on and recommendations for HIV testing, only 38.4% had read the policy document. CONCLUSION: There is a growing need to provide care, support and treatment to a large number of PLHA. The capacity of healthcare providers must be urgently built up so as to improve their knowledge of and attitude to HIV to enable them to deliver evidence-based and compassionate care to PLHA in various healthcare settings.

A 5-yr prospective epidemiological study of chronic obstructive pulmonary disease in rural south India.

In a prospective epidemiological study from 1981 to 1986 in four villages belonging to the KV Kuppam block of North Arcot Ambedkar district in Tamil Nadu, we detected 328 patients of chronic obstructive pulmonary disease (COPD) amongst the 9946 inhabitants who were aged 30 yr or more. Majority of the population was from the lower income group and they were agricultural workers residing in these villages which were generally free from atmospheric pollution. Of the 328 patients with COPD, 198 were males and 130 were females showing an overall age specific prevalence of 33.0/1,000 with a prevalence of 40.8/1,000 for males and 25.5/1,000 for females, respectively. In nearly half of the patients who had chest radiography, changes consistent with COPD were observed; only one patient had clinical, radiological and electrocardiographic evidence of cor-pulmonale. Peak expiratory flow rate (PEFR) along with height (cm) were measured in 258 patients and compared to the predicted normal values. Most of those tested showed evidence of airways obstruction; severe defect was observed in 106 patients. Among the males, 122 gave a history of smoking; majority of the heavy smokers amongst them had severe impairment of PEFR. Females from these villages denied any history of smoking. Cooking for long hours using firewood and cowdung cakes could have contributed to the development of COPD in these village women.