Malaria: radical treatment for falciparum malaria in chloroquine resistant strain areas.

PIP: A trend exists in areas hyperendemic for Plasmodium falciparum (PF) malaria toward an increasing frequency and degree of resistance to chloroquine therapy. Aside from intense PF transmission in the northeastern sector of India, there is constant population movement particularly across the international border with Bangladesh. Resistance is high and widespread in those areas. Chloroquine resistance has also been observed in project areas, with some tendency toward increased resistance. The first reported confirmed case of PF resistance to chloroquine treatment was detected in Karbi-Anglong district in 1973, and then in the following year in Nowgoan. On the basis of a series of studies conducted in India, national drug policy was developed for the first time in 1982. Drug policy has since been revised in areas where significant portions of resistant cases have been detected. A list of areas with revised drug policies is presented, followed by guidelines on the radical treatment of chloroquine-resistant PF.^ieng

Towards a rational drug policy for malaria.

PIP: It has been observed that medical professionals in India lack awareness about the rational therapeutic aspects of malaria. This situation is leading to untimely exposure of the malaria parasites to newer drugs and eventual development of drug resistance. The indiscriminate use of the anti-malarial drug Mefloquine is a cause of great concern. This article contains some of the recommendations made by a committee of medical experts that reviewed the National Drug Policy on Antimalarials. It is stated that Mefloquine can be used for treatment of Plasmodium falciparum cases resistant to chloroquine only and not for the treatment of Plasmodium vivax cases. Thus, it is recommended that the Drugs Controller of India stipulate strict conditions for import, sale and use of Mefloquine through a depot system, where 1) it should be mandatory that the drug is issued only when prescribed by a qualified registered medical practitioner and 2) the prescription should be accompanied by a laboratory report issued by a qualified parasitologist indicating the presence of Plasmodium falciparum rings in the peripheral blood. Other concerns about Mefloquine as well as suggestions for an effective and rational Drug Policy on Antimalarials are also discussed.^ieng

Towards effective policies and strategies for control of HIV / AIDS.

PIP: As of July 31, 1996, 2639 AIDS cases had been reported to India's National AIDS Control Organization, more than 75% of which are thought to be the result of HIV transmission through unprotected heterosexual intercourse. The screening of blood samples from almost 3 million individuals found an HIV-seropositivity rate of 15.97/1000 population. The level of HIV prevalence varies across the country. An estimated 5 million people will have been infected with HIV in India by 2000 if the rate of infection remains at the current level. The National AIDS Control Program launched in India in 1987 has been strengthened and consolidated for 1992-97. However, with HIV infection and AIDS continuing to spread in India, a new and better approach to prevention and control is needed. The HIV pandemic is most severe in places and among people facing obstacles to learning and effecting behavioral change. Belonging to a discriminated, marginalized, or stigmatized groups reduces personal capacity to learn and respond. Interventions are therefore needed to reduce the societal risk factor of discrimination in order to strengthen the personal capacity of people who are most vulnerable to HIV/AIDS. Policies and strategies to address various HIV/AIDS-related concerns are offered.^ieng

TB and AIDS.

PIP: The Indian National Tuberculosis Survey has indicated that 10 million persons above 5 years of age have pulmonary tuberculosis (TB), of whom 2.5 million are infectious. The annual infection rate amounts to 1.5%. In an average district with a population of 1.5 million, there are about 500 active, infectious TB cases and about 20,000 radiologically active cases. The World Health Organization has declared TB a global health emergency. The pandemic of AIDS had infected 13 million people worldwide by early 1993, and by the year 2000 over 40 million will be infected. In May 1986 only 1 AIDS case was reported, but by May 31, 1994, 728 cases of AIDS and 15,325 cases of HIV infections were reported. At the present rate of infection, there will be 5 million people infected with HIV by 2000 in India. HIV infection is the greatest risk factor for developing TB because of the multiplication of tubercle bacilli in quiescent foci, the progression of dormant infection to disease, and superinfection. The incidence of TB has doubled in the course of 5 years in some countries where HIV is epidemic. 30-70% of TB patients in these countries are estimated to be HIV-positive, imposing significant burden on national health services. On the other hand, efficient health services can still cure TB in HIV-positive patients and forestall the spread of the diseases. One-third of the world's population is infected with TB, and the lives of these people are shortened if they contract HIV. Worse still, for HIV-infected people exposure to TB means death, often within weeks. The only protection against the airborne TB germ is the complete cure of TB patients. At a 1993 conference in London several TB control measures were suggested: national TB control programs offering affordable treatment; faster diagnosis; education and incentives to increase patient compliance; proper drug supplies and quality control; education of influential people; and fight against poverty.^ieng

Country watch: India.

PIP: Linking more than 3000 health and development organizations, the Voluntary Health Association of India (VHAI) is one of the largest networks in the country. In 1990 VHAI began incorporating HIV/STD-related activities into its broader programs. An existing infrastructure for intersectoral collaboration in the areas of community health promotion, public policy, information and documentation, and communications facilitated inclusion of the new activities. Several VHAI departments collaborate in offering training courses, workshops, and seminars at the state and community levels to involve nongovernmental organizations and professional groups in HIV/STD prevention and counseling. More than 950 persons have been trained so far, including trainers of primary health care workers, family physicians, medical practitioners, social scientists, teachers, community volunteer workers, and youth leaders. Local experts act as training resource persons; materials produced locally, abroad, and by VHAI itself are used. Training facilities are offered free of charge to member organizations; VHAI also awards fellowships for field training and financial support for approved projects. VHAI suggests intervention measures to governmental and nongovernmental organizations related to drug users, youth, truck drivers, blood donors, and people living with HIV/AIDS. The information, documentation, and communications departments provide members with a wide variety of information, education, and communication (IEC) materials that can be translated into local languages: posters, folders, flip charts, stickers, and folk songs. VHAI advocacy issues that have been highlighted through the press include: confidentiality, protection against discrimination, the right of all persons to health care, and the need to make properly-equipped STD clinics available. VHAI has established sub-networks in Tamil Nadu (155 organizations) and Manipur (55 organizations) states. VHAI has found that incorporating HIV/STD activities into its general health education programs is more cost-effective than having a vertical program.^ieng

Shocking findings in Manipur.

PIP: A sero-surveillance program in the state of Manipur, India revealed an alarmingly high rate of HIV infection, detected primarily among intravenous drug users. Previous surveillance had indicated that heterosexual intercourse was the leading mode of HIV transmission, and in 1989, no HIV infections had been detected in Manipur. But in February 1990, 5 HIV-positive cases were reported, and by May 1991, 1263 had been reported -- 93.9% of them among intravenous drug users. This came as shocking news, considering that at the same time only 5131 HIV cases had been reported in all of India. Although Manipur makes up only 0.91% of the country's population, the state's intravenous drug account for 23.1% of the nation's HIV cases. Manipur has an estimated 30,000 drug addicts, approximately 1/2 of which are intravenous drug users. Heroin is easily available in Manipur, due to the fact that the state shares a common international border of 352 km with Myanmar, one of the 3 countries that make up Southeast Asia's heroin producing "Golden Triangle." The author stresses, however, that drug abuse is not the cause of the transmission of HIV. It is the sharing of needles and syringes among intravenous drug users that creates the risk of infection, and preventive measures should reflect that fact. Besides discouraging drug use, preventive measures will require a dual strategy: 1) until they are cured, intravenous drug users should be given sterilized needles and syringes to avoid sharing; and 2) the law needs to be revised so that drug addicts are treated as patients and not as criminals. The Voluntary Health Association of India has begun to discuss such measures with governmental and nongovernmental organizations involved in the prevention and control of AIDS.^ieng

Prevention and control of AIDS: the role of NGOs.

PIP: Because of their ability to more easily provide services to high-risk groups, non-governmental organizations (NGOs) will play a critical role in any successful AIDS prevention program. Since HIV is often transmitted through behavior deemed intimate or taboo, government health officials have a difficult time reaching the affected group. But NGOs, which have a long record of involvement in the field of health and social welfare, possess several advantages over government agencies: 1) they have rich experience working at the community level; 2) their autonomous nature allows them to respond more quickly; 3) they have access to marginalized groups; 4) they generally work with the target groups to raise their self-esteem; 5) they can act as a bridge between the community and the national level; 6) they often employ innovative methods; and 7) their method of operation allows for cost- effectiveness. Furthermore, NGOs can choose their own areas of involvement according to their feasibility, past experience, and priorities. NGOs can be instrumental in providing information on HIV infection and AIDS to the public particularly to special target group populations -- the young, women of reproductive age, prostitutes, and intravenous drug users. Additionally, NGOs can work in policy advocacy, in providing training for different groups, in providing counselling and other assistance to those affected by HIV, in screening donated blood, and in caring for AIDS patients. Though offering a great vehicle for combating the epidemic, NGOs will have to overcome several obstacles, including lack of government support, and lack of funds and resources.^ieng

AIDS: understanding cause and effect.

PIP: This article discusses the history, pathology, and symptoms of AIDS. Caused by Human Immunodeficiency Virus (HIV), AIDS was first detected in 1981 among the American homosexual population, later spreading to other populations, including hemophiliacs and intravenous drug users. This led epidemiologists to deduce that AIDS spreads through body fluids. In 1983, French scientists isolated the virus which late came to be known as HIV-1. And in 1987, scientists identified another virus capable of producing the AIDS symptoms, HIV-2. Belonging to the group of retroviruses, HIV incorporates itself into the genetic constitution of the host cell, allowing it to reproduce alongside the host cell and causing a permanent infection. The retrovirus, however, may not cause any ill effect for years. AIDS develops from a breakdown of the immune system, a result of the fact that HIV infects and destroys a specialized group of white blood cells called T-helper of T-4 cells. And with the breakdown of the immune system, severe opportunistic infections develop. Since it spreads through body fluids, HIV transmissions occur through sexual activity, blood transfusions, and from infected mother to child before or shortly after birth. The period from the time of infection to the development of HIV symptoms varies considerably, anywhere between 4 months to 10 years or longer. Although a person may be free of symptoms, he or she can still pass the virus to someone else. An estimated 75% of those infected with HIV develop AIDS by the end of ten years. The major signs of AIDS include: at least a 10% body weight loss, chronic diarrhea for over a month, and prolonged fever (whether intermittent or constant). Currently, no cure for AIDS exists, only treatment drugs that help delay death.^ieng

Kala-azar in Varanasi (UP)--preliminary observations.

An epidemiological and entomological survey was conducted in Badohi town of Varanasi district of Uttar Pradesh (India) from where an outbreak of kala-azar was reported. Serological and clinical results showed 83 cases who responded to sodium antimony gluconate. Phlebotomus argentipes and P. papatasi could be detected in area of outbreak. An active transmission of kala-azar is strongly indicated.

Screening for seroprevalence of HTLV-III/HIV infection in high risk groups in Delhi.

PIP: Serum samples from a total of 1505 (826 males and 679 females) individuals belonging to various categories of Delhi based high-risk groups, such as those attending clinics which treat sexually transmitted diseases (n=700), prostitutes (n=348), jail inmates (n=325), drug addicts (n=26), blood donors (n=11), those clinically suspected AIDS cases (n=89), and those who underwent coronary bypass surgery abroad during the past 3-4 years (n=6) were screened for the presence of antibodies to HTLV-III/LAV/HIV virus. The commercial Wellcozyme AIDS ELISA kit was used and none of the serum samples tested positive for the HTLV-III virus.^ieng