EMBARGOED UNTIL 00:01HRS GMT FRIDAY 27 OCTOBER 2006
AIDS epidemic in India ignoring unsafe healthcare in spread of virus
India’s efforts to control its HIV epidemic are based on insufficient information about routes of transmission, and may fail if widely-ignored risks from blood exposures in healthcare are not investigated and stopped.
The findings are published in a series of related articles and a review in the Royal Society of Medicine’s International Journal of STD & AIDS.
Findings are based on field research directed by Mariette Correa during 2005 in four districts with high HIV prevalence in south India and on a review of previous studies.
Study researcher David Gisselquist said Indian authorities had to address the real causes of the country’s HIV epidemic.
“Evidence of unsafe healthcare practices must be properly addressed. India has the expertise, capability and health institutions to tackle these causes of HIV infection,”said Dr Gisselquist.
“The Indian Government must resist international pressure by organisations such as the World Health Organization and UNAIDS to only focus on unprotected heterosexual sex as the cause for the continued spread of HIV.”
HIV through healthcare and cosmetic services in India
Researchers found that people with HIV infections received a wide range of invasive procedures in health care and cosmetic services, including injections, blood tests, dental care, and tattoos. Based on discussions with patients and health staff and observations in clinics, the study team found that re-use of unsterile instruments is common. In one incident, women in sex work reported standing in line for tattoos administered without changing needles or inkpot between customers. The general public as well as most medical professionals mistakenly believe that HIV survives no more than seconds to minutes outside the body.
Routes of HIV transmission
Using evidence from field research, one of the articles evaluated the reliability of information on routes of transmission. India’s National AIDS Control Organization reports that 86% of HIV infections are from sexual transmission. This information comes from hospital staff, who assess and report routes of transmission for inpatients with AIDS. The study found that reporting forms provide no space for hospital staff to report blood exposures other than transfusions and injections. Medical forms make no distinction between higher risk sex (such as anal sex among men) and lower risk sex (such as non-commercial heterosexual contacts, even with condoms). Many counsellors and doctors assign AIDS cases to the category sexual acquisition on the basis of any non-marital sex, or even suspicion of sex exposures, without asking about blood exposures.
Heterosexual commercial sex in India
The hypothesis that heterosexual commercial sex accounts for most HIV infections in India has guided HIV prevention programmes for two decades. Female sex workers are seen to account for more than half of HIV infections. However, the review found that these results depend on unrealistic assumptions about numbers of sex workers, extent of condom use in commercial sex, and rates of HIV transmission. With best and high evidence-based estimates, sex workers and clients account for not more than 2% to 13% of HIV infections in India. The study found that the prevailing hypothesis is inconsistent with evidence and very likely wrong.
A companion editorial review in the International Journal of STD & AIDS challenges the managers of India’s HIV efforts to reconsider their assumptions about India’s HIV epidemic. If prevention efforts are guided by wrong assumptions imported from other countries, India’s HIV prevention programs will waste money and time while HIV spreads through injections, dental care, tattoos, and other blood exposures.
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Routes of HIV transmission in India: assessing the reliability of information from AIDS case surveillance [PDF 71k]
How much does heterosexual commercial sex contribute to India’s HIV epidemic? [PDF 84k]
Reconnaissance assessment of risks for HIV transmission through health care and cosmetic services in India [PDF 87k]
Review: A passage to India’s HIV epidemics: sending out an SOS [PDF 48k]
The following papers are published in the November 2006 issue of the International Journal of STD & AIDs (Vol.17) by M Correa and D Gisselquist:
1. Routes of HIV transmission in India: assessing the reliability of information from AIDS case surveillance
2. How much does heterosexual commercial sex contribute to India’s HIV epidemic?
3. Reconnaissance assessment of risks for HIV transmission through health care and cosmetic services in India
Review: A passage to India’s HIV epidemics: sending out an SOS by JJ Potterat.
IJSA is published monthly by the Royal Society of Medicine. Its Editor is Professor Wallace Dinsmore.
