HIV and India: looking into the abyss.
Serosurveillance of high risk groups started in India in October 1985. The first positive cases were detected in 1986. As of mid-1994, official figures stood at 15000 HIV positive cases and 559 cases of AIDS. This is most certainly an underestimate because of under reporting. Among high risk groups, prevalence has risen rapidly. Between 1986 and 1994, prevalence has risen from 1.6 to 40.0% in sex workers, 1.4 to 40% in STD clinics and 0 to 70% in i.v. drug abusers in various studies. The penetration into the general population is uncertain. As in Africa, infection has been mainly by heterosexual intercourse, with commercial sex workers, long distance truck drivers and migrant labour serving as vehicles of spread. Other routes of infection are transfusion of blood and blood products and i.v. drug use. Dependence on professional blood donors is the main cause of infected blood supplies. Ninety per cent of cases with HIV infection are aged between 15 and 45 years and belong to socioeconomically disadvantaged groups. The male to female ratio is 5:1, with female cases being mainly sex workers. The predominant virus is HIV-1 but cases with HIV-2 and mixed infection are being reported from port cities. The present situation in India is similar to the early pattern in Africa where a sharp increase in seroprevalence among high risk groups was followed by spread to the general population. Clinical AIDS is still infrequent. From experience so far, pulmonary tuberculosis has been the most common clinical presentation. So far AIDS associated tuberculosis has responded to standard therapy but the development of multi-drug resistant mycobacteria and their spread to the large tuberculous population in the country is a potential threat. Key factors of AIDS/HIV prevention are public education and counselling about the infection and safe sex practices, especially in high risk groups; STD control; promotion of voluntary blood donation and adequate screening of blood products and general and equitable progress in the economic development of the country and its people-much high risk behaviour is driven by poverty.
Pais
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Department of Medicine, St John's Medical College Hospital, Bangalore, India.
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D001782:Blood Donors; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D015497:HIV-1; D015498:HIV-2; D006266:Health Education; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D015995:Prevalence; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D012944:Social Support; D015819:Substance Abuse, Intravenous / Q000517:prevention & control