Calls for sustained efforts and international collaborations dominated the International Health Organization’s (IHO) fourth AIDS–India conference, hosted at HSPH on December 2. IHO is Boston-based and has worked in the Indian Subcontinent since 1992.
Since 1986, when the first AIDS case was reported in India, HIV has spread rapidly there, said A.S. Rathore, joint director of the Advanced Centre for AIDS and Related Diseases at India’s National Institute of Communicable Diseases. By 2005, more than 5.1 million Indians were infected, the second highest number of infected persons in a single country after South Africa.
Speakers at the conference offered detailed reports about the latest prevention and training programs. They shed light on the cultural, social, and religious barriers to dealing effectively with the epidemic’s spread. They also highlighted major challenges ahead and ideas for meeting them.
Some progress has been made, noted IHO President Bikash Verma, who outlined the Regional AIDS Training Program and Network (RATNEI). Begun in 2002, this IHO program trains and educates health workers and the general population at the state, district, and village levels. More than 2,000 doctors, nurses, health workers, paramedics, and others were trained in RATNEI’s first year.
Keynote speaker Teresita Schaffer, director of the South Asia Program with the Center for Strategic and International Studies in Washington, D.C., noted that medical tools alone will not solve the crisis. She outlined India’s challenges in fighting HIV/AIDS, such as competing health priorities like malaria, tuberculosis, and polio. "Any programs targeting AIDS must be sustainable enough to survive and flourish in the face of these other threats," she said.
While expressing appreciation for U.S. governmental and private assistance, Schaffer also called for changing roles. She sees a need for India to "move away from its role as aid recipient," so that the relationship between India and the U.S. "becomes a longterm collaboration between equals."
Schaffer also emphasized that social and behavioral changes will be critical in arresting the virus’ spread. Yet those changes are also among the most daunting transformations to make.
Other speakers expanded on the cultural norms theme. Nalini Tarakeshwar, an assistant professor at Yale University School of Medicine, discussed how stigmas associated with AIDS make its prevention and treatment extremely complex and difficult in India. Many Indians perceive no risk to themselves of contracting HIV "because only stigmatized groups are seen as vulnerable," she said. "People with AIDS are thought of as being responsible for contracting the disease."
Renee Ridzon, who is a senior program officer with the Bill and Melinda Gates Foundation’s HIV, TB, and Reproductive Health Program, discussed how HIV is increasingly impacting women. Just under half of all people infected with HIV are females, and that proportion continues to grow.
To help women and girls in Africa, the Foundation has initiated diaphragm and microbicide studies. Some evidence suggests that the diaphragm can protect a woman from infection because it covers the cervix. Further, "the diaphragm can be used without the partner’s knowledge," Ridzon noted, a fact that could help women whose partners or husbands may disapprove of its use. A trial with sites in Zimbabwe and South Africa is testing the diaphragm as a means to prevent HIV infection.
Microbicides are being studied in a 6,300-woman trial begun in March 2004. Aside from providing lubrication and thereby reducing tissue irritation, microbicides "could target and disrupt HIV, and could help maintain healthy vaginal flora," Ridzon said. Even a 60 percent efficacy rate "could prevent two and – a – half million HIV infections. So it’s important to consider."
Fellow speaker Tarakeshwar took issue with this idea for India. "Women [in rural India particularly] don’t make their own decisions about their health care," she said. They would not, for example, use preventive measures if their husbands disapproved. They would also be unlikely to use them without their husbands’ knowledge, as they would feel it was wrong to do so. "Any intervention that targets only women is doomed to fail, in my opinion," she said.
Whichever new interventions get underway in India, "there is no time to lose," said Schaffer, who advocated for the U.S. and India to work vigorously toward a sustainable fight against the disease. "But this is a marathon, not a sprint." The fight against AIDS in India "requires a very stubborn, determined, and systematic approach," she said.
For more details about AIDS in India, the conference, or IHO’s work in India/South Asia, contact IHO at 617-254 5077 or at iho@usa.com, or visit www.ihousa.org.
—EM
Copyright, 2009, President and Fellows of Harvard College
