Aids Epidemic Paradigm Shift Necessary

By P.Gopakumar

IN Nepal, people living with AIDS are often ostracised by their communities. It is high time to enact policy to uphold their rights and dignity. It is important to dispel the ignorance about HIV and AIDS. Ignorance and fear lies at the root of discrimination and stigma. It is important to cultivate scientific temper and help people comprehend the medical reality of AIDS. The time has come to articulate a paradigm shift in our perception of AIDS. HIV and AIDS are chronic manageable conditions that need acceptance, care, support and compassion like chronic diseases. For, if HIV and AIDS do not kill, the stigma, discrimination, exclusion and isolation will.

Care

Several years may pass before a person living with HIV falls ill. Until then, people living with HIV can lead a relatively normal productive life by taking good care of their health through regular medical check ups and anti-retroviral therapy if necessary, and taking care not to donate blood, share needles or indulge in sex without condoms. HIV is not transmitted via skin -to -skin contact and there is no reason to isolate someone living with HIV due to fear of causal contagion. The unfortunate tendency to keep linking HIV transmission to unlawful for amoral activities has resulted in the general population mentally distancing themselves as being beyond the reach of the virus.

Changing popular perceptions about AIDS requires massive inputs of information, education and communication, sensitisation of opinion makers and political leaders at all levels, and maybe some modification in legislation. Of course, we have made a beginning. These efforts need to be given more momentum.

Nearly two million children in Asia have lost one or both of their parents due to AIDS. But Nepal did not furnish its count of AIDS orphans. This may be because of the less seriousness in the approach or it might have felt 'too uncomfortable". This is where a second paradigm shift is necessary. We need to educate the community not to forsake the responsibility of caring for children because their parents perished in an epidemic. I strongly believe the joint family system will continue the tradition of caring for orphans in the family. There is also need for an effective mechanism to estimate the number of AIDS orphans. However, the survival of the parents is equally important. Therefore, we should work towards a combination of institutional and home-based care initiatives to ensure the long-term survival of both mother and child. As Nepal has about 1-2 million deliveries a year, mother to child HIV prevention is critical.

The Long-term survival of people living with HIV is dependant on anti-retroviral therapy. But the majority of the patients find patented drugs and even generics unaffordable. We are depending upon the import of medicines and drugs from the neighbouring countries, mainly from our southern neighbour, as it is the largest producers and exporters of low-cost generic drugs. Ironically, excise duty on pharmaceutical products' export to Nepal is waived off by the government of India; still medicines are not affordable in this country. There is a need to deliberate with representatives from the pharmaceutical industry and traders, donor agencies and health service providers.

A rational policy of standard treatment regimens for HIV and AIDS need to be adopted. Such a policy should detail modalities for expanding access to these regimens and consider social marketing and franchising to enhance the availability of HIV-related products and services. There should not be failure to link HIV prevention with care and support.

Evolving special methods and means to counter impact of the fearsome disease has now become critical in the fight against AIDS.AIDS researchers intrigued that 1 to 5 per cent of the people infected by HIV can live for 10 or 15 years or even more, with apparently no damage to their immune systems. The scientists call these untreated people long-term non-progressors. Using defensins as a medicine might be difficult, in part because they are hard to manufacture. But clues to treat AIDS might come from understanding how the defensins work, which is unknown. Dr. Bruce walker, director of the AIDS division at the Harvard medical school, said defensins might not be that useful therapeutically because they appear to have only fairly modest effect in suppressing the virus. Some people might withstand the virus because of genetic variations or because a weak virus might have infected them.
Skeptics say the data on HIV/AIDS in Nepal is neither comprehensive nor accurate. There is a need to work towards increasing the number of sites, to refine modalities for estimation with a view to enhancing coverage and accuracy.

A comprehensive package of services for vulnerable segments and also refining strategies for HIV prevention should be evolved and also work on providing support and care for people living with HIV and AIDS. The focus on identifying gaps in the existing systems and strategies with regard to the geographical heterogeneity of the spread of the epidemic is needed and should work towards upgrading community level HIV surveillance. There is also need to work towards professionalising health delivery systems that deal with the logistics, management and delivery of safe blood. The specifications and standards for drugs, instruments, equipments and accessories that are utilised in the national AIDS program need to be better articulated.

Cooperation

All this can only be accomplished through multi-sectoral cooperation, community awareness and participation, initiatives from the private and the non-governmental agencies and explicit political will and commitment.

AIDS, Social Awareness & Role Of Media

By Shirish B. Pradhan

IT is alarming to notice that every day 30 Nepalese are infected with HIV (Human Immunodeficiency Virus) the deadly virus, according to a latest report. The total number of infected people are estimated to be over 60,000 and till the date there are reported cases of 2,524 HIV positive people, two third of them men. Media can play a greater role in creating awareness about the deadly disease among the general public. Acquired Immuno Deficiency Syndrome or AIDS, has so far claimed 153 lives of Nepali people since its first appearance in 1988.

Vulnerable

Young people, specially, the age group between 20 and 29 are the most vulnerable to the disease. Though medical science has not yet invented any drug that can cure AIDS but there are measures to prevent it and ways to minimise its effects. People should change their habits and way of living to stop its' spread like an epidemic. Media, specially, electronic ones, can play a vital role in spreading the education and awareness about AIDS and HIV.

If we look into worldwide scenario it is much more alarming to notice that 40 million people are living with HIV/AIDS and 5 million new HIV cases were reported in the year 2001 alone. So far 3 million people have died of the deadly disease.

The disease first spread in developed countries like Europe and America, but later it spread in the continents of Africa and Asia. These two continents house a large number of uneducated, poor and backward population. Education and awareness are the two powerful instruments which can check the spread of the disease. NowAsia, and even more South Asia has become vulnerable to the HIV and AIDS because of lack of awareness, widespread poverty and fast growing sex trade in the region.
Nepal is sandwiched between two big neighbours, India in the South and China in the north with a combined population of over 2 billion. There is every possibility of people crossing the border with the virus and spreading to our healthy people. Every year thousands of Nepalese girls are sold to Indian brothels and when they return home they do not only bring back the money but also the deadly virus. Therefore, vigilance is required not only to control illegal trade but also to check the spread of the disease.

The disease is found not only among sex workers but also among housewives and new born babies. A latest study says that 459 sex workers, 1557 sex clients, 159 house wives, 299 syringe users and 28 newborn babies are infected with HIV at present. Thus, the message of safe sex should be spread to each and every household member across the country through aggressive media campaign.
However, health workers and activists involved in HIV education have complained that due to the Maoist insurgency they are facing problem to spread the message to the remote villages. In fact, the guerillas themselves are in a way helping the spread of the disease through unchecked sexual activities of their young comrades, which they need to take seriously.

The number of drug users is also increasing in the country with the rise in unemployment and growing frustration among the youths. At present sixty eight per cent of the HIV positives in Nepal are the drug users. There are reported cases of 299 HIV positives among drug users who use syringes.

The disease is linked to poverty, illiteracy, unemployment and many other social problems. It is a silent killer as it may spread without our knowledge. Some people hesitate to test while others simply do not disclose it because they want privacy. In such cases there more risk of transmitting the disease throughout the country. So far, AIDS awareness campaign is centred in the urban areas, leaving the vast population, who mainly inhabits in the rural area unadressed in this matter.

To control the spread of the disease demands responsible behaviour from the general public. Using contraceptives, avoiding risky physical contacts, stopping to share needle, being alert while doing blood transfusion are the basic points to be considered to prevent the disease from spreading. Media can play a big role in helping the society to become aware of the HIV/AIDS by focusing on its different aspects. Instead of concentrating in few cities the media should also penetrate into the rural communities and spread the message relating to AIDS.

Thailand, the once famous spot for sex tourism, has now adopted new ideas and innovative techniques to fight the deadly disease. Break the Needle, Dr. Sex Hotline and Dr. AIDS Hotline are some of the new techniques adopted by the Thai people to control the rapid spread of the disease in its latest moves.

Lesson

We should also learn from the lessons derived from other countries' experiences. The government, non-governmental bodies and media all should cooperate in spreading the awareness to the general public on how to prevent the spread of the deadly disease and minimise its effects. Now a days there are growing number of FM stations in cities outside the valley, which can play greater role in educating the people of HIV/AIDS.

Drive Against HIV/AIDS

By Balaram Chaulagain

WHILE HIV/AIDS has raised its ugly head more vigorously then before, the disease poses increasingly serious problems across the globe, affecting the health of millions of people. Fighting HIV/AIDS is a challenging job.

As per an estimation, some 25 million people have died of AIDS since the first appearance of the deadly disease some two decades ago. The acquired immuno-deficiency syndrome (AIDS) is a fatal illness caused by a retro virus, popularly known as human immuno-deficiency virus (HIV) that destroys body's immune system. Consequently, the victim becomes vulnerable to a host of life threatening diseases. AIDS is a last stage of HIV infection having no specific treatment hitherto except prevention through health awareness and counseling. The virus is found in great concentration in blood, semen and cerebro spiral fluid. Besides, lower concentrations have been detected in vaginal and cervical secretion, urine, saliva, tears etc. However, to date, blood and semen have been conclusively proved to be the main means to transmit the virus. Sexual transmission, blood contact, maternal-foetal transmission are major modes of transmission.

AIDS is first and foremost a sexually transmitted diseases which is equally transmitted through intravenous drug users as well. Thus, prostitution, intravenous drug users are number one attributing factors for HIV/AIDS prevalence.

Apart from the fact that it can kill, it threatens family structures, communities, socio-economic development and future of nation. Moreover, the stigma and discrimination attached to the scourge also have an impact on people's dignity. The AIDS epidemic is still in early stage. It is estimated that the disease will cause the early death of 60 million people between 2000 and 2020 AD.

The statistics released by UN source say that there are approximately 60 thousand people afflicted by HIV in Nepal making it the most pressing public health issue. Nepal is set to suffer the next big wave of pandemic unless we act now. It so, the country will experience the same socio-economic devastation as elsewhere where family structures are breaking down, the number of orphans are rising continuously and pace of development have been hampered.

The government has set up AIDS control programme under the Ministry of Health. International line agencies also are incessantly pouring fund to curb the meance but the cases of diseases are still on the rise.

It is not only a health related problem but also a social one. Therefore, all social sector, media, political force including health care system simultaneously must take part to wipe out the disease.
Prevention through information, communication and education regarding the disease is the best option for us. It is high time to intensify awareness drive against the malady. The government efforts alone are not sufficient to attain this goal pubic participation is equally needed.

Prostitution within and outside the country, free sex habit, sharing of one syringe among drug users, use of un-sterilised syringes and other medical instruments in time of innoculation and operation and such others are precursor for HIV/AIDS prevalence. As such, priority should be accorded high in this direction so as to make everyone aware about such practices.

Lastly, it goes without saying that all nations should focus on every country's AIDS crises when the epidemic breaks out from especially vulnerable groups into the wider population. Unless we see national prevention initiatives championed by the highest level of government, the growth in infections can be unstoppable. Attempts should be focused on awareness campagins and prevention programmes that are at last starting to break the chain of HIV among their young. Otherwise we have a narrow window of opportunity to prevent the epidemic from becoming much worse. But it is an irony to note that many governments, especially the South Asian nations still do not see the epidemic as an issue which needs to be addressed with urgency.