Beginning of a novel experiment in politics

Dr Sandeep Pandey, Magsaysay Awardee and CNS Columnist
With the formation of Aam Aadmi Party government in Delhi the country is going to witness a novel experiment in politics. The first target has been the VIP culture. Arvind Kejriwal has refused to accept security, beacon fitted vehicle and a government bunglow not only for himself but all his ministers. In a country where most people become politician to avail of all these facilities it is going to be a trend setting decision. In fact, the facilities given to people’s representatives and bureaucrats should be drastically cut down. This is an unnecessary wastage and burden on the tax payer.

Break the Back of Tobacco Industry Interference

Hom L. Shrestha - CNS 
The World Health Organization (WHO) and its allies are taking a bold step to challenge Big Tobacco’s bullying and ‘intimidation by litigation’ by exposing the undue influences of Tobacco Industry (TI) and are responding to the industry’s disregard to the sovereignty of governments to protect health of its citizens. The WHO FCTC (Framework Convention on Tobacco Control) enshrines effective tobacco control initiatives across the globe and has been ratified by 175 countries, protecting nearly 90% of the world’s population from tobacco health hazards. Article 5.3 of FCTC guidelines explicitly recognizes the need to protect tobacco control programmes from commercial and other vested interests of the tobacco industry.

The long road ahead

Shaleen Rakesh - CNS
On 11 December 2013, the streets outside the Supreme Court of India thronged with a dazed crowd, hugging, sobbing and not quite sure what had happened. Inside the hushed courtroom, the judges had just passed a devastating ruling. Lesbians, gays, bisexual, transgender (LGBT) in India had once again been labelled as criminals. Section 377, the 149-year-old colonial law that banned gay sex, had been upheld by the Highest Court of Law of India saying that amending or repealing Section 377 should be a matter left to Parliament, not the judiciary.

Surgeons championing the cause of treating people living with HIV

Despite evidence to prevent occupational exposure to HIV for surgeons and other healthcare providers, people living with HIV (PLHIV) requiring surgical procedures for treatment often face heightened stigma and get discriminated within healthcare settings. But all is not that black and there are surgeons who have championed the cause of treating PLHIV without stigma and challenged discrimination in healthcare settings as well. Few of these surgeon-heroes were sharing their experiences of over 20 years in treating PLHIV at the 6th National Conference of AIDS Society of India (ASICON 2013).

"Co-infections and HIV beget each other": Dr Dilip Mathai

(This article is based upon a CNS interview with Professor (Dr) Dilip Mathai, Dean, Apollo Institute of Medical Sciences and Research)
Dr Dilip Mathai (left): ASICON 2013
HIV in today's context is a chronic condition of the human immune system. HIV is a retrovirus and the infection leads to a progressive reduction in the number of CD4+ T-helper cells (so called because CD4 glycoprotein is found on their surface) which are an essential part of the human immune system. They are the main targets of HIV which destroys infected CD4 cells leading to an overall weakening of the immune system, said Dr Dilip Mathai, Dean, Apollo Institute of Medical Sciences and Research, and former Head of Medicine Department, Christian Medical College (CMC), Vellore.

Human Papilloma Virus (HPV) and HIV co-infection pose a daunting challenge

A study found that prevalence of human papilloma virus (HPV) among women living with HIV was 26.85% which was much higher than the HPV rates in HIV-negative women. Dr Ankita Chourasia, a researcher from Banares Hindu University (BHU) whose oral presentation of this study was awarded at the 6th National Conference of AIDS Society of India (ASICON 2013), strongly recommended regular HPV screening for women to cut down rates of HPV-caused cancers such as cervical cancer. HPV is the most common sexually transmitted infection (STI).

Partners-in-crime: HIV and Hepatitis B Virus (HBV)

AIDS is just one of the manifestations of HIV, said a veteran health advocate. A range of co-infections and co-morbidities also need as much attention as AIDS-related treatment and care. HIV and hepatitis B virus (HBV) co-infection was in spotlight at the 6th National Conference of AIDS Society of India (ASICON 2013). HBV is a viral infection that attacks the liver and can cause both acute and chronic disease. Mode of transmission of HBV and HIV both are similar: they get transmitted through contact with the blood or other body fluids with high viral load of an infected person. About 600,000 people die every year due to the consequences of HBV.

How can you treat your illness unless you take your medicines?

To tackle any disease it is not merely only diagnosing correctly and offering quality treatment but ensuring that the patients adhere to treatment that is of paramount importance. Timely and correct diagnosis and availability of standard, evidence-based and effective treatment cannot be of much help unless the patient takes the prescribed drugs for the complete duration of time. So over and above everything else it is the patients' willingness and determination to take their medicines regularly that can bring relief.

No excuse to not end HIV transmission to children

An estimated 3.4 million children are living with HIV, thus accounting for 10% of the total global HIV infected population. At the same time, the number of children newly infected with HIV dropped drastically by 52% between 2001 and 2012. And yet as per the UNAIDS Global Report 2013 currently only 34% of children under 15 years of age in need of antiretroviral therapy (ART) in the world are actually receiving it. This is just half of the ART coverage for adults. To reach the goal of an AIDS-free generation we have to focus on elimination of HIV in children.

Cardiovascular diseases threaten to reverse gains made in treating HIV

Although historic scale-up of antiretroviral therapy (ART) is keeping people living with HIV (PLHIV) alive, 1 in 10 of them succumb to cardiovascular diseases (CVDs). “The good news is that survival of PLHIV has improved, but CVD is increasingly becoming one of the important causes of morbidity and mortality” said Dr K Naik of Lokmanya Tilak Municipal Medical College (LTMMC), Mumbai. Dr Naik was speaking at the 6th National Conference of AIDS Society of India (ASICON 2013).

How has India done in its fight against AIDS?

On one hand the new mantra of ‘zero new HIV infections, zero deaths and zero AIDS-related stigma and discrimination by 2015’ is increasing decibels and on another hand Indian AIDS response is dealing with a complex matrix of challenges impeding programme outcomes. To compound the situation there are policy conflicts against public health such as the Supreme Court’s decision to re-criminalize same sex behaviour that further will slow down the AIDS response in the country (as men who have sex with men and transgender people are HIV key affected populations as per the government’s National AIDS Control Organization).

Growing thrust for combination HIV prevention

One size does not fit all. Likewise we need an expanded basket of evidence-based interventions and approaches to meet the unique needs and contexts of different key affected populations to prevent HIV. Deliberations on the first day of the 6th National Conference of AIDS Society of India (ASICON 2013), discussed amongst other things, effective strategies for HIV prevention and control.

ASICON 2013 calls for fully utilizing domestic competencies in fighting AIDS

The 6th National Conference of AIDS Society of India (ASICON 2013) which has brought together over 700 HIV medical experts from across India with a distinguished national and international faculty opened in Mumbai. Dr IS Gilada, President of the conference and also of AIDS Society of India (ASI), said: “to strengthen south-south collaboration between Africa and India and to promote mutual information exchange and learning in fight against AIDS, ASICON 2013 is being inaugurated by Minister of Health from Tanzania.”

ART, preventing HIV spread to children and TB-HIV in-focus at ASICON-2013

Shobha Shukla - CNS
Mumbai will be host to the 6th National Conference of AIDS Society of India (ASICON 2013) from 13th to 15th December. As its theme HIV/AIDS: Scaling New Heights – From Prevention & Treatment …Towards Cure suggests, the conference will focus on vital issues in the journey of the HIV epidemic from prevention and treatment towards possible cure. 45 national and 25 international eminent speakers are expected to share their expertise on a variety of subjects during this 3 day long event, informed Dr IS Gilada, President, AIDS Society of India.

Gender Mainstreaming in TB-HIV Response-A private sector response

Alice Tembe - CNS
In this years' event, the Swaziland Business Coalition on HIV-AIDS (SWABCHA) launched the integration and mainstreaming of gender in the HIV and TB response programmes in the workplace. The  US Ambassador to Swaziland, Ms Makila James, the guest speaker, said in her remarks that  the progress and milestones gained so far in the HIV and TB response will go to waste if due diligence is not accorded to the gender dynamics at play in the society. She noted that gender based violence, has undoubtedly contributed to new infections among the Swazi population. Further, these two epidemics,  have increased the burden of care on women and reduced the chances of women growing in the workplace as they are bound to withdraw from work to care for their loved ones.

Leave no one behind

Dr Carolyn Kavita Tauro - CNS
Recently, Ahmedabad was host to an International Conference on Inequity in Maternal and Child Health organized by the Indian Institute of Public Health (IIPH) Gandhinagar and Public Health Foundation of India (PHFI). It brought together national and international public health professionals to discuss about various issues affecting an equitable delivery of health care to mothers and children in India.

Deploying technology, managing treatment well - makes the difference!

Xpert MTB/RIF in Delhi
Bobby Ramakant - CNS
There is no doubt that research and development of new diagnostic technologies and effective drugs must go ahead with full thrust. But there is no single 'magic wand' intervention and therefore deploying existing diagnostic tools optimally and managing treatment well are no less a priority to reach the formidable tuberculosis (TB) related goal of zero new infections, deaths and suffering.

HIV-TB threats globally

Chhatra Karki - CNS
(First published in Kapan Online, Nepal on 1 December 2013) 
Since the governments have not taken effective integrated steps for controlling HIV-TB, the challenges to control the two diseases continue to compound and experts rue over the absence of effective programmes to prevent TB infection in HIV infected people. It is well known that there is a much higher possibility of TB infection in people living with HIV (PLHIV) than in those who are HIV negative. Researches reveal that they have an estimated 21 to 26 times greater risk of developing active TB once infected.  In 2012, among the 35.3 million PLHIV in the world, 11.8 million were also infected with TB. Globally 320 000 PLHIV co-infected with TB lost their lives in 2012. The number of these deaths would have been less, if somehow TB infection in them was prevented.

Malawi’s HIV/TB treatment challenge

Sam Banda Jnr - CNS
The world, on December 1, joined hands to commemorate the World AIDS Day which every year gives an opportunity to people to renew their commitment to the fight against HIV, advocate for the rights of people living with HIV (PLHIV), and remembers brothers and sisters who died of AIDS related conditions. Malawi is one of the countries in sub-Saharan Africa which is severely affected by the HIV-epidemic. The TB-HIV co-infection is one of the prime challenges that this Southern African country continues to battle and the NTP Programme Manager James Mpunga notes that the high mortality rate of the TB-HIV cases is mainly due to diagnostic challenges. TB is the most prevalent opportunistic infection in HIV patients and Mpunga says it contributes significantly to HIV associated deaths in Malawi and Africa as a region.

Living with HIV but dying of co-infections, co-morbidities

Bobby Ramakant - CNS
Neglecting Hepatitis C Virus (HCV), Hepatitis B Virus (HBV), Visceral Leishmaniasis (VL), tuberculosis (TB), among other HIV co-infections and co-morbidities threaten to reverse gains made by remarkable scale up of HIV specific services. Number of people who inject drugs (PWID) with HCV is 3.5 times higher than those infected with HIV. Number of people infected with HBV is not behind at 6.4 million PWID exposed to it in 59 countries. 1.2 million PWIDs are estimated to have developed chronic HBV infection.

MDR-TB HIV co-infection among Injecting Drug Users

Dr Sugata Mukhopadhyay - CNS
Overall 10% of HIV infections globally, and excluding Africa nearly 30% of all new HIV infections are attributable to IDUs. About 20% of 15.9 million IDUs globally are infected by HIV. Drug Users have 10-30 times more chances of TB diseases and IDUs living with HIV have a 1 in 10 chance of TB disease per year as evidenced by scientific studies.

TB/HIV co-infection: Why is ICAAP silent?

Dr Sugata Mukhopadhyay - CNS
“I am infected with HIV and not scared of AIDS, but definitely of TB. I know TB can knock me down at any time.” Space to discuss crucial issues of TB/HIV co-infection and management appears to be extremely limited in the current ICAAP. Surprisingly, community advocates and activists are also not very vocal on what should be a burning issue for the region.

Healthy Migrants For Healthy Communities

Shobha Shukla - CNS
(Based on an interview with Gilles Cesari Regional Director, International Union Against Tuberculosis and Lung Disease (The Union)
Every year nearly 9 million people continue to suffer from TB. Among them, 3 million people are not diagnosed or misdiagnosed or not started on treatment and care-- and many of these are migrants. It is estimated that there are approximately 200-250 million migrants (documented, undocumented, refugees, asylum seekers, etc) in the world. Unfortunately, migrant workers are more vulnerable to develop active TB disease or get infected by HIV because of their poor living/working conditions, low wages, poor nutrition, overcrowded living quarters, no or little access to healthcare (especially undocumented migrants).

World AIDS Day:Experts Call for Scaling of HIV-Tuberculosis Treatment

Joseph Elunya, Uganda 
(First published in The Continent Observer, Uganda on 30th November 2013)
As countries around the world commemorate the World AIDS Day on Sunday 1st December experts are calling for the scaling up of treatment for Tuberclosis and HIV/AIDS. The experts note that with more than one million people needing simultaneous treatment for TB and HIV, it is essential that services for the patients be scaled up and coordinated within the general health system.

The AAP phenomenon and what it means for us

Dr Rahul Pandey
In the past several days I have been a part of Aam Aadmi Party (AAP)'s campaigning in Matiala constituency of Delhi.  In this small period I have been witness to some inspiring processes and moments – motivation and hard work of persons volunteering for AAP; responses of people from various strata to AAP’s canvassing; decentralized and chaotic yet, in some ways, organized management of AAP’s campaign activities at the levels of constituencies and wards; and AAP’s unique model of local and democratic governance with a hint of Gandhi’s vision of ‘Swaraj’ or ‘Self-rule’.