Emerging issues in HIV infection

Sir,

In July 2007, the Indian Health Minister, Dr. Ambumani Ramadoss announced that the number of people estimated to be living with HIV/AIDS in the country is about 2.47 million, or half of previous estimates, according to United Nations-backed government estimates. The new estimate decreases India′s HIV prevalence from 0.9 to 0.36%, Ramadoss said. The new estimate was calculated with the assistance of international agencies, such as the United Nations and USAID (United States Agency for International Development. ^[1]

No doubt, the recent reports about HIV/AIDS are encouraging, still there are certain newly emerging issues arising about the disease. Few of those issues are mentioned below:

1. Women and children are increasingly becoming vulnerable to HIV/AIDS. The new findings conclude that 38% of infected persons in India are women. The male-female ratio of infected people shifted from 55 per 100 males in 2001 to 60 per 100 in 2005. This indicates the increasing feminization of HIV/AIDS in India. ^[2] There are many more complex reasons for this new trend of feminization with biological, social, cultural and economic factors playing different roles. Gender inequality, discrimination on the basis of sex and all forms of violence against women are root causes that foster the spread of the pandemic.
2. As first-line antiretroviral drugs fail to work for people with HIV/AIDS, the need for second-line antiretroviral drugs will arise. However, these are costly and remain beyond the reach of most. Nearly 5,000 to 6,000 HIV-positive people in the country who have developed resistance to first-line antiretroviral drugs depend on second-line drugs. ^[3] The monthly cost for second-line antiretroviral drugs is $239 per person, compared with an annual cost of $239 per person for first-line medications. ^[4]
3. Another emerging problem about HIV/AIDS is the children orphaned by AIDS, which includes those under the age of 18 who have lost one or both parents to the disease. India today is home to the largest number of AIDS orphans in the world. Although there are no government figures in the country for the number of children affected by AIDS, World Bank estimates suggest that the number of children in India orphaned by AIDS is approaching 2 million. The proportion of orphaned children is expected to double by 2010 and remain exceptionally high until 2020 or 2030. ^[5] This issue of AIDS orphans is another ugly face of this killer disease.
4. Over 35% of reported AIDS cases are below 25 years of age and 50% of new infections are in the age group of 15-24 years. ^[2] According to National Family Health Survey-3 (NFHS 3), only 80% of men and 57% of women have ever heard of AIDS. Furthermore, only 68% of men and 35% of women know that consistent condom use can reduce the chances of getting HIV. The results underscore the pressing need to educate women and men about the virus, how it is transmitted, and how it can be prevented. Increasing HIV/AIDS education will be a critical step to curbing the number of new HIV cases in India. ^[6]

To conclude, the National AIDS Control Program is in its third phase and there is an urgent need to consider these newly emerging issues in HIV/AIDS while formulating the control strategies in the future to address these issues efficiently. This is essential to sustain the success of India′s efforts in controlling HIV/AIDS.