A constitution for AIDS.

PIP: The Indian Health Organization projected the number of deaths per day due to AIDS by the year 2000 at 10,000. An interdisciplinary international conference was held in New Delhi to draft an international law governing the issues related to AIDS. Human freedom and public health policies are the most affected by this disease. In the absence of an international AIDS law, judicial verdicts set precedents and could have serious ramifications. A participant from the John Marshall Law School, Chicago, suggested that instead of making new laws, the existing ones from the colonial past should be repealed. This includes Section 377 of the Indian Penal Code, which provides criminal sanctions against those who indulge in unnatural relations with man, woman, or animal. Penalizing homosexuality will only perpetuate clandestine relations and spread the virus into their families. Another participant seconded this motion stating that even a sex worker must be protected from abuse and indignity. The National AIDS Control Organization responded to the criticism that the government had not utilized all the World Bank funds allocated for anti-AIDS projects. The trends of the epidemic were the most important indicators not just the numbers. In Manipur and Mizoram, infection was almost entirely due to injecting drug use. The Saheli project undertaken in the red-light areas of Bombay encompassed brothel owners and prostitutes, which could be replicated in other areas. Because existing government policies were focusing on prevention, there was no protection of an HIV-infected individual's privacy, one participant from Madras stated. The confidentiality issue was also echoed by a US participant. The New Delhi Declaration and Action Plan on HIV/AIDS was also discussed. It forbids discrimination in employment, education, housing, health care, social security, travel, and marital and reproductive rights. Providing sterile needles and ensuring the safety of the blood supply were other concerns mentioned.^ieng

Gender discrimination weighs heavily down on babies.

PIP: During a pediatric conference in New Delhi, India, physicians compared their experiences with various diseases to the body of knowledge contained in Western-oriented medical textbooks. One physician noted that the most important longterm intervention to prevent low birth weight babies and congenital malformations is social and involves reducing discrimination against women in India. Many childhood disorders, such as thalassemia, can be prevented by proper genetic screening. Children with thalassemia depend upon blood transfusions to survive, yet they can contract serious and life-threatening illness from an unsafe blood supply. Another physician implicated improper handling by parents in habit disorders such as thumb sucking. A report on childhood epilepsy noted that 20% of the cases are resistant to therapy. A session on nephrotic syndrome relayed the practical experiences of the pediatricians. The fact that this syndrome recurs until puberty and, thus, requires longterm management makes it an important pediatric topic. Asthma was described as a condition which is increasing and which parents are afraid to acknowledge. Another physician suggested adding childbirth to the list of medical emergencies in India, since 75% of them are attended by untrained personnel who may contribute to the incidence of death from neonatal tetanus.^ieng

Charging the vas deferens -- a novel male contraceptive method.

PIP: A new male contraception method is undergoing clinical trials in India. The goal of this research is to achieve a method which restricts its effects to the region of the vas deferens. First, the belief that there was a strong peristaltic movement in the vas during ejaculation had to be examined. It was found that only the ampula part of the vas is given a tight squeeze to release the stored sperm into the semen. Therefore, a device to manipulate sperm could safely be inserted into the vas. Using the fact that the acrosomal membrane of the sperm is disturbed when sperm are subjected to electrical currents, Dr. S. K. Guha, of the Indian Institute of Technology in New Delhi, decided to try to generate a current inside the vas to disturb the acrosomal membranes. Since styrene maleic anhydride (SMA) hydrolyses when mixed with body fluids, it creates a slight charge. After injecting SMA into the vas, the electrical balance of the sperm which passes it is disturbed, causing the acrosomal membrane to shrink and rupture, letting water enter the sperm. When the sperm head bursts, the enzymes acrocin and hyaluronidase are released. Without these enzymes, the sperm can not penetrate the ovum and fertility control is achieved. This procedure can be reversed by injecting a solvent to dissolve the SMA in the scrotal sac. Phase I clinical studies began in 1989, and the next Phases should begin soon. The advantages of this method include the fact that no surgical procedure is required, sperm production is not actually blocked so there is no rise in anti-sperm antibody titres, and the contraceptive action can last as long as 10 years. Dr. Guha cautions, however, that education of the people will ultimately play a more important role in population control in India than the availability of a variety of contraceptive methods.^ieng

Immuno-contraception undergoing promising trials.

PIP: Immuno-contraception instructs the body to recognize a self-molecule as foreign, so that the body attacks the molecule, thereby effecting contraception. When researchers in India were developing a contraceptive vaccine, they considered 3 things: the targeted molecule should be crucial for reproduction, it should be transient in nature, and the antibodies against this molecule should not cross-react with other molecules in the body. They have developed a vaccine using beta-human chorionic gonadotropin (hCG). The pregnant woman's body produces beta-hCG. It sustains the corpus luteum for production of progesterone which induces changes in the uterus conducive to implantation of the zygote. Researchers have linked beta-hCG with a carrier molecule (tetanus toxoid or diphtheria) to induce an immune attack. They have successfully completed phase 2 efficacy trials. This vaccine also protects against tetanus or diphtheria. Animal studies show that it does not have any harmful side effects and is reversible. The phase 2 trials included women with 2 children cohabiting with fertile partners. Once the antibody titres surpassed the protective threshold, they discontinued contraceptive use and any avoided pregnancies would be attributed to the vaccine alone. The trials exceeded the norm of 750 protected menstrual cycles for the vaccine to be considered efficacious in April 1993. Researchers continued to monitor the women until their anti-beta-hCG titres reached a near-zero level. They are now ready to begin phase 3 trials. Logistical obstacles to overcome are a 2 month-lapse between 1st dose and sufficient titres to protect against pregnancy and multiple injections. Neem oil use may provide protection during the lag phase since it stimulates immune cells in the reproductive tract and has embryocidal and spermicidal effects. A single injection of biodegradable microcarrier systems releasing the vaccine may address the problem with multiple doses.^ieng

Planning sex of baby -- the Barthakur method.

PIP: The sex of any given human zygote is dependent upon when the ovum is placed in the fallopian tube. Dr. Inderjit K. Barthakur's has developed a way for heterosexual couples to conceive either male or female children depending upon the timing of their coitus. To have a baby of preferred gender, a couple should have coitus in accordance with the advice of a well-informed instructor who can determine the exact date of rupture of the Graafian follicle with ultrasound scanning. The method requires these preconditions: keeping a temperature chart from 3-4 months before the month in which the pregnancy is planned, abstaining from sex during that particular month until the time advised by the instructor, and having daily ultrasound scans after the 9th day of the menstrual cycle to ensure the highest degree of accuracy in identifying the best time for intercourse. Accurate sex determination of the fetus has occurred in 71 of 72 cases managed by the four physicians who practice this method in India. A more simple alternative which is easily communicable to the poor and uneducated has also been developed by the doctors, but it is only 80% successful. These high rates of success have generated widespread international interest, but the ICMR, the Health Ministry, and others have turned down appeals to support studies of the method because they do not want to encourage potential discrimination against females. Abortion, however, which is often gender-biased, is legal. Dr. Barthakur and her colleagues ensure that the couples taken for instruction should desire a child of the sex opposite to the existing one and no tests are conducted after conception to confirm the sex of the fetus. Under current funding constraints, all expenses for the procedures are met jointly by the involved doctors and couples who are well-off enough to go in for repeated ultrasounds.^ieng