THE ROAD AHEAD

The probable options which may be used in the Indian circumstance to fight with the deadly disease of HIV & AIDS are being discussed here.

It is well know that there are mainly three types of known transmissions related with the HIV virus:

1. By Sexual Activities with the infected person
2. By Use of Contaminated Blood or Blood Products
3. From Infected Mother to her Child

Not discussing in seriatim, the third issue is being dealt with first.

Mostly HIV can be transmitted from mother to child in three ways. It can occur in the womb, at the time of delivery and also when the child is breast-fed.

1. During Pregnancy: When the mother has a high viral concentration in the blood, some of the virus can pass from the mother to the foetus through the placenta. A small number of foetuses get infected through this route.
2. At the time of birth: The lining of birth canal (Vagina) contains a high concentration of HIV. The baby may sustain minor cuts in the mucous membrane and in the skin during the process of birth. Hence the baby can get infected. 30% to 40% children get infection through this route.
3. Breast milk: About 14% of children who are breast fed by HIV infected mothers will contract the infection.

In the aforesaid cases the transmission may only be checked by the early identification of virus in the females and then mothers should be guided in this regard about the probabilities of transmission, probable consequences, how to proceed so that the risk may be minimize and the applicable medication. These all should be done in a very friendly manner and in personal counselling way so that the individual should get environment to think positively about the issue. Whenever required other family members of the individual may be involved in the process of decision making.

In relation with the next issue of transmission of HIV through Use of Contaminated Blood or Blood Products the most important factors are the various agencies and inputs involved in the process of blood transmission, various vulnerable groups with risk behaviours, other vulnerable groups with different diseases, etc.

It is well known that we get blood and blood products for transfusion from voluntary donors and professional donors. In our country rate of voluntary blood donation is very low so a big part of our blood banks is fed by professional donors who may due to their specific risk behaviours, have HIV virus.

In order to avoid the transmission of HIV virus through blood and blood products the first and the most important thing is that in all cases, the blood must compulsorily be checked for HIV before transfusion. For this the government and voluntary agencies should provide help to the blood banks by educating their staff, by providing proper facilities for testing and by mobilizing the voluntary blood donation by government servants and other persons by providing them some special facilities etc. If we have a very strong system of checking of blood before transfusion then the chances of HIV transmissions may be minimal.

Although in general blood transfusion should be preferred from a known person after proper checks and the general public must be educated in this regard specially by posters or hoardings at sensitive places like hospitals, blood banks etc.

On account of poverty and unemployment and to get money for drugs, liquors etc. some people professionally get involved in the work of blood donation. Some of them due to their risky behaviours of taking drugs, or multiple sexual relationships etc. have chances of getting and transmitting HIV virus. They mostly suffer from very poor health also. But no education or other thing will stop them from doing these except helping them to fulfill their basics needs by various government schemes and voluntary organisations and by establishing very good relations with winning their confidence and then trying to motivate them for behaviour modifications by various practical methods. Only such behaviour modification may have long lasting effects. A team of doctors, psychologists, social workers, educationists, psychiatrists, HIV Educators etc. should be formed for this purpose and they must visit various sensitive areas like slums etc. for this purpose.

For those how are suffering from the diseases like Hemophilia etc. some arrangements should be done to develop a network for them who can donate blood to them whenever they need it after specific time intervals etc. For this the family members, relations, friends related with the individual and social organisations and other persons may be mobilized.

The last but the most sensitive part is the transmission of HIV virus by Sexual Activities with the infected person.

There are mainly three types of sexual activities:

1. Vaginal
2. Anal
3. Oral

It is well known that the HIV virus may enter into the body by breach of mucous membrane which is possible in all the three cases.

Prostitutes, persons who moves from one place to the other mostly like truck drivers, drug abusers, street children are various groups which are very sensitive to the infection due to their or others’ risky behaviours.

In India sex is not considered as a topic of discussion openly in society. People mostly avoid talking about the issue and the topics related with it. Although it can easily gathered from various literatures that all the three types of sexual activities prevail in society in one form or the other, both rural and urban areas, in different form between male and females, males and males, lesbians, or between males and eunuchs. Although mostly we consider that the sexual intercourse should be between the married couples but we cannot deny the presence of other relations in our society too. So any type of sexual relationship outside married couples is a highly risky behaviour for the purpose of transmission of STDs and HIV.

Lack of education, poverty, lack of facilities for entertainment in rural and slum areas, no sex education, improper facilities for identifying and treating STDs and HIV are some of the various factors which effects the issue too.

The various aspects to control the transmission of STDs and HIV like distributing condoms, posturing etc. are only effective upto a very limited extent. But if we study the social, cultural, economical structure of our society, we can easily identify that weaker condition of females in society and risky behaviours are the two main reasons which contribute most in transmission of HIV virus in India.

If we educate females exclusively making separate groups of them like college students, housewives, working women etc. in relation with the aspects of how to live life in a better way to help them and their family may be an effective way to communicate and pass necessary information to them. For this purpose programs should be made by considering the interest of all the areas separately including hygiene, vocational trainings, entertainment etc. With this they should also be provided information related with sex, sexual life, their body, use of contraceptives including female condoms and how to avoid STDs and HIV. This program should be at a large level and in all rural and urban areas to get best of the results.

Similarly, if we program for behaviour modification of the vulnerable groups involved in risky behaviour in a practical manner, we may get the slow result in starting but will get very good and constant results in future. For this various vulnerable groups should be identified and proper studies should be done in respect of their economical, social and cultural backgrounds. Their various basic needs should also be identified. Then with the help of government organizations and schemes and various NGOs and other social organisations and their resources these programs should be run to rehabilitate and readjust them in the society. For these the involved agencies should have to establish very good relations with them. In this way they can be motivated to avoid their risky behaviours and so we can avoid the transmission of HIV.