AIDS, public health and the panic reaction (Part II)

Natl Med J India. 1994 Nov-Dec;7(6):288-91.

Abstract

PIP: Salient points of AIDS control in India are summarized. An autonomous national AIDS control organization has been set up, which received a sizable loan from the World Bank. As a result, the central health budget became skewed with one-fourth of its expenditures going for AIDS and not enough spent on general health services. Among issues inadequately addressed are: 1) HIV surveillance; 2) diagnosis of AIDS; 3) appropriate and safe medical care; 4) wasteful expenditure; 5) educating health workers; and 6) blood bank services. HIV surveillance and testing centers have been attached to a few large hospitals and medical colleges, but more testing and treatment services will be needed. The World Health Organization (WHO) recommends testing only after informed consent has been obtained; however, in India this is impossible because of the high rate of illiteracy. Instead, counseling is provided by special social workers and testing is prescribed by doctors. Special AIDS clinics might be the solution, although they lead to isolation and stigmatization of patients. Doctors and nurses should be made aware about the importance of informed consent and counseling to encourage voluntary and anonymous testing. The present WHO definition of AIDS for diagnosis is too general and is based on the African experience. Its use may lead to misdiagnosis of many cases of tuberculosis, diarrhea, and malnutrition as AIDS. Clinical criteria applicable to the Indian reality need to be developed urgently. Private practitioners have also entered HIV testing, but often they rely only on the ELISA test without confirmation which might result in a high rate of false positives. General medical care of AIDS cases have to be strengthened with routine sterilization to avoid wasteful expenditures, health workers have to be reeducated, blood bank services need to be streamlined, and more AIDS-related research is also required.

MeSH terms

  • Acquired Immunodeficiency Syndrome / diagnosis
  • Acquired Immunodeficiency Syndrome / prevention & control*
  • Blood Banks / standards
  • Health Education / organization & administration
  • Health Education / standards*
  • Humans
  • India
  • National Health Programs / economics
  • National Health Programs / organization & administration
  • National Health Programs / standards*
  • Population Surveillance
  • Research