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Hivaids In India Brs


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Hivaids In India Brs

  2. 2. <ul><li>What is the nature of the HIV/AIDS epidemic in India ? </li></ul><ul><li>Magnitude of the epidemic: </li></ul><ul><ul><li>3.82-4.58 million HIV-infected people (NACO,2003) </li></ul></ul><ul><ul><li>1.2 % of the adult population 15-49 years overall </li></ul></ul><ul><ul><li>610,000 new infections in 2002 </li></ul></ul><ul><ul><li>40-72% female commercial sex workers are HIV-infected in major metropolitan areas (Mumbai, Pune, Chennai etc.) </li></ul></ul><ul><ul><li>20% STD patients are HIV-infected in selected urban centers </li></ul></ul>
  3. 3. Determinants and Distribution: <ul><ul><li>Mode of transmission: </li></ul></ul><ul><ul><ul><ul><li>predominantly heterosexual in major states </li></ul></ul></ul></ul><ul><ul><ul><ul><li>IDU-related in Northeastern states </li></ul></ul></ul></ul><ul><ul><li>“ Differential” Epidemic : High, Medium & Low prevalence states </li></ul></ul><ul><ul><li>Complex multidimensional determinants </li></ul></ul>
  4. 4. When did the epidemic start and how did it grow ? Source: Population Ref. Bureau & Government of India / NACO 2003
  5. 5. When did the epidemic start and how did it grow ? Source: Population Ref. Bureau & Government of India / NACO 2003
  6. 6. Maharashtra Karnataka Tamil Nadu Manipur Nagaland Andhra Pradesh Current status of the HIV/AIDS epidemic in India Source: Population Ref. Bureau & Government of India / NACO 2003
  7. 7. Mumbai / Bombay New Delhi Chennai / Madras Current status of the HIV/AIDS epidemic in India Source: Population Ref. Bureau & Government of India / NACO 2003
  8. 8. <ul><li>General population </li></ul><ul><li>Married women </li></ul><ul><li>Babies and Children </li></ul><ul><li>Youth </li></ul><ul><li>Men </li></ul><ul><li>Bridge populations </li></ul><ul><li>Clients of sex workers </li></ul><ul><li>Migrant / mobile populations </li></ul><ul><li>Truck drivers </li></ul><ul><li>Populations in conflicts </li></ul><ul><li>High-risk Populations </li></ul><ul><li>Sex Workers </li></ul><ul><li>Trafficked women </li></ul><ul><li>Men who have sex with men </li></ul><ul><li>Needle sharing drug users </li></ul>Transmission of HIV from High-risk to Low-risk (general) population through bridge populations
  9. 9. <ul><li>Where is the epidemic going ? </li></ul>The hitherto predominantly urban epidemic is moving into the rural areas with the male migrant workers infecting their village-based married, monogamous wives  children 2.7 million AIDS deaths in India between 1980 and 2000. UN Population division projections: 12.3 million AIDS deaths between 2000-15 49.5 million deaths during 2015-50 National Intelligence Council: CIA (Sept., 2002) “ The Next wave of the HIV/AIDS pandemic” India : 20-25 million HIV-infected people by 2010.
  10. 10. <ul><li>The global epidemic of HIV/AIDS is rapidly becoming the worst infectious-disease catastrophe in recorded history, surpassing the Bubonic Plague of the 14 th century and the influenza epidemic of 1917, each of which killed 20 million people. </li></ul><ul><li>Greater than 20 million people have already died because of AIDS, according to UNAIDS, which coordinates the United Nation’s response to the epidemic. </li></ul>
  11. 11. What is HIV? <ul><li>The Human Immunodeficiency Virus is a virus that attacks and deteriorates the body’s immune system. The immune system is the body’s natural defense against infections such as the common cold. HIV is the virus that causes AIDS. </li></ul>
  12. 12. What is AIDS? <ul><li>AIDS stands for Acquired Immune Deficiency Syndrome. </li></ul><ul><li>By name, we can understand a lot about the disease. It is Acquired, meaning that it must be transmitted from an outside source. </li></ul><ul><li>It affects the Immune system, and cause a Deficiency. This means that it causes the body’s natural defense to be worn down. </li></ul><ul><li>It is a syndrome which simply means that it is a general name for a number of common symptoms. AIDS is not a virus in itself. It is simply a name for the later stages of HIV. </li></ul>
  13. 13. Why do people infected with HIV eventually die? <ul><li>When people are infected with HIV, they do not die of HIV or AIDS. These people die due to the effects that the HIV has on the body. With the immune system down, the body becomes susceptible to many infections, from the common cold to cancer.It is actually those particular infections and the body’s inability to fight the infections that cause these people to become so sick, that they eventually die. </li></ul>
  14. 14. How do you become infected with HIV? <ul><li>By having sexual intercourse with an infected partner.This includes ORAL, ANAL, and VAGINAL. It makes no difference if the person is gay, straight or bisexual. It makes no difference if it is a guy or girl, or what age the person is. In fact the fastest growing segment of our population that is becoming infected with HIV are heterosexuals (straight), and between the ages of 18 and24. </li></ul>
  15. 15. <ul><li>By injecting drugs using a needle or syringe which has already been used by someone who is infected. </li></ul><ul><li>HIV can be passed on in both ways because the virus is present in the sexual fluids and blood of infected people. If infected blood or sexual fluid gets into your blood, then you will become infected. </li></ul><ul><li>HIV can be found in primarily four bodily fluids. If you can remember the four bodily fluids, you can remember how HIV is transmitted. HIV can be present in blood, vaginal fluids, semen, and breast milk. </li></ul>
  16. 16. <ul><li>Underlying Causes </li></ul><ul><li>Weak political commitment </li></ul><ul><li>Poverty </li></ul><ul><li>Gender inequality </li></ul><ul><li>Lack of dialogue on sexuality </li></ul><ul><li>Young people and HIV </li></ul><ul><li>Population movement </li></ul><ul><li>Human rights infringements </li></ul><ul><li>Immediate Causes </li></ul><ul><li>Sexual transmission </li></ul><ul><li>Mother-to-child transmission </li></ul><ul><li>Shared blood and blood products </li></ul><ul><li>Unsafe needles and injections </li></ul><ul><li>Immediate Effects </li></ul><ul><li>Households </li></ul><ul><li>Children and young people </li></ul><ul><li>The health sector </li></ul><ul><li>Long-Term Effects </li></ul><ul><li>Demographic impact </li></ul><ul><li>Inter-generational consequences </li></ul><ul><li>Macro-economic impact </li></ul><ul><li>Sectoral Impact </li></ul>Causes and Impacts of HIV/AIDS A Conceptual Framework
  17. 17. How should we win the battle ? <ul><li>Awareness </li></ul><ul><li>Advocacy </li></ul><ul><li>Funding </li></ul><ul><li>Research </li></ul><ul><li>Mobilization </li></ul><ul><li>Interventions </li></ul>
  18. 18. How ??? 1. Awareness
  19. 19. How ??? 1. Awareness
  20. 20. How ??? 2. Advocacy / Activism
  21. 21. How ??? 4. Mobilization
  22. 22. How ??? 5. Research
  23. 23. How ??? 6. Interventions
  24. 24. Prevention <ul><li>There are a few simple ways to protect yourself and others against HIV. </li></ul><ul><li>They include abstinence, using a male or female condom, and never sharing a needle when injecting drugs. </li></ul>
  25. 25. Reasons for The Rapid Spread of HIV/AIDS <ul><li>Social </li></ul><ul><ul><li>Healthcare </li></ul></ul><ul><ul><li>Government Response </li></ul></ul><ul><ul><li>Education </li></ul></ul><ul><ul><li>Drug Use </li></ul></ul><ul><ul><li>Gender Inequality </li></ul></ul><ul><ul><li>Migration </li></ul></ul><ul><ul><li>Homosexuality </li></ul></ul>
  26. 26. <ul><li>Cultural </li></ul><ul><ul><li>Premarital Sex </li></ul></ul><ul><ul><li>Women </li></ul></ul><ul><ul><li>Stigmas </li></ul></ul><ul><ul><li>Denial </li></ul></ul><ul><li>Economic </li></ul><ul><ul><li>Sex Commercial Trade: Prostitutes </li></ul></ul><ul><ul><li>Developing Country </li></ul></ul>
  27. 27. Cultural Stigmas <ul><li>Fear of HIV </li></ul><ul><li>AIDS = DEATH </li></ul><ul><li>Prevents individuals from being tested </li></ul><ul><li>Anti-Aid Programs </li></ul><ul><li>Infected individuals have violated a taboo </li></ul><ul><li>India’s new “untouchables” </li></ul><ul><li>Emotional and behavioral responses to the trauma of HIV </li></ul><ul><li>Social and cultural evolution? </li></ul>
  28. 28. Premarital Sex and Protection <ul><li>Premarital Sex </li></ul><ul><ul><li>India’s “moral” character </li></ul></ul><ul><ul><li>Sex absent from entertainment </li></ul></ul><ul><ul><li>Reluctance to acknowledge sexual behavior </li></ul></ul><ul><li>Condom distribution </li></ul><ul><ul><li>Socially unacceptable </li></ul></ul><ul><ul><li>Government plans to facilitate condom usage have failed </li></ul></ul>
  29. 29. Sex Commercial Trade <ul><li>Sex Industry </li></ul><ul><ul><li>Draws workers from other countries </li></ul></ul>
  31. 31. Gender Inequality and Women <ul><li>Literacy levels low amongst women </li></ul><ul><li>Women are not aware of methods of protection </li></ul>
  32. 32. Women in a Cultural Context <ul><li>Women are more susceptible </li></ul><ul><li>Treatment of women in households </li></ul><ul><li>Women Unable to Protect unborn child: Antenatal Transmission </li></ul>
  33. 33. <ul><li>HIV/AIDS and Other Sexually Diseases </li></ul><ul><li>sexually transmitted diseases (STDs) continue to be a major cause of distress, disability and sometimes death of both sexes </li></ul><ul><li>HIV/AIDS in particular, is continuing to spread, killing millions of women and men in the prime of their lives </li></ul>Gender and Risk
  34. 34. <ul><li>AIDS is becoming an increasingly female affair </li></ul><ul><li>Heterosexual transmission is now dominant in most parts of the world </li></ul><ul><li>HIV infections that occurred are nearly half were in women </li></ul><ul><li>Women now account 42% of the people living with HIV </li></ul>Gender and Risk
  35. 35. <ul><li>This increase in the number of HIV positive women reflects: </li></ul><ul><li>their greater biological vulnerability to the disease </li></ul><ul><li>a consequence of the social constructions of female and male sexuality </li></ul><ul><li>profound inequalities that characterise many heterosexual relationships </li></ul>Gender and Risk
  36. 36. <ul><li>Biologically, the risk of HIV infection during unprotected vaginal intercourse is two to four times higher for women than men. </li></ul><ul><li>women have a bigger surface area of mucosa exposed to their partner’s sexual secretions during intercourse </li></ul><ul><li>Semen also contains a higher concentration of HIV than vaginal secretions </li></ul>Gender and Risk
  37. 37. <ul><li>semen can stay in the vagina for hours after intercourse </li></ul><ul><li>co-existing STDs, increase the risk of HIV infection by three to four times (and in some cases five to six times) </li></ul><ul><li>women are biologically more vulnerable </li></ul><ul><li>50-80% of STDs in women have no symptoms or have symptoms that cannot easily be recognised </li></ul><ul><li>are too ashamed to visit a doctor </li></ul>Gender and Risk
  38. 38. <ul><li>This biological vulnerability is too often reinforced by socially constructed constraints on women’s ability to protect themselves </li></ul>Gender and Risk
  39. 39. <ul><li>men be the initiators </li></ul><ul><li>be perceived powerful </li></ul><ul><li>be seen as risk-takers (‘not afraid’) </li></ul><ul><li>Many women find the heterosexual relationship a difficult one in which to negotiate a strategy for their own safety. </li></ul>Gender and Risk
  40. 40. <ul><li>In many societies sex continues to be defined primarily in terms of male desire with women perceived as passive recipients </li></ul><ul><li>women may find it difficult to express their own needs </li></ul><ul><li>find it difficult to assert their wish for safer sex </li></ul><ul><li>find it difficult to negotiate for their partner’s fidelity or no sex </li></ul>Gender and Risk
  41. 41. <ul><li>For many women, their economic and social security is dependent on the support of a male partner </li></ul><ul><li>fear of abandonment can be a powerful force </li></ul><ul><li>discrimination against divorced or separated women and their children </li></ul>Gender and Risk
  42. 42. <ul><li>no legal right to refuse conjugal sex </li></ul><ul><li>the threat of physical violence or abuse </li></ul><ul><li>many women will prefer to risk unsafe sex in the face of more immediate threats to the well-being of themselves and their children </li></ul>Gender and Risk
  43. 43. <ul><li>If a woman does become infected with HIV or with any other STD, gender inequalities may affect the progression of the illness and possibly her survival chances. </li></ul><ul><li>The exclusion of women from many research studies on HIV/AIDS has had the additional effect of prolonging the male bias in research. </li></ul>Gender and Risk
  44. 44. <ul><li>The combination of unequal access to care and the gender gap in medical knowledge contributes to a situation where women in both rich and poor countries have a shorter life expectancy than men after a diagnosis of AIDS </li></ul>Gender and Risk
  45. 45. Hope