Progress, challenges and opportunities for HIV prevention and control among high risk groups: a public health perspective

  • Authors

    • Renu Gupta IHBAS
    • Sarbjeet Khurana IHBAS
    • Ravinder Singh IHBAS
    2014-10-09
    https://doi.org/10.14419/ijm.v2i2.3564

  • Abstract

    Aim of the study: To study various factors linked to the prevention and control of HIV-AIDS in the high risk groups in India.

    Objective of the study:

    1)     To study the socio-cultural and political obstacles in the prevention and control of HIV-AIDS in India.

    2)     To study the factors responsible for poor access of antiretroviral therapy (ART) in India.

    Methodology: The relevant published literature was searched for studying various factors in the prevention and control of HIV-AIDS as well as for the factors responsible for the poor access of ART in India.

    Observations: There are various socio-cultural issues/obstacles in prevention of HIV-AIDS in high risk group for e.g., gender inequality, power inequalities and male dominance; condom use believed to be in conflict with the cultural importance for procreation; poverty, illiteracy, increase in migrant population and unemployment; poor knowledge and awareness of reproductive and sexual health and sexuality; emergence of new urban sub-culture and physical or mental abuse at a young age. Lack of awareness and access to health care; misconceptions; stigma and discrimination, leading to secrecy of their high risk behavior and hence the further spread of the disease.

    There are various political obstacles viz; HIV-AIDS control program has a focus on short term goals rather than long term sustainable achievements; minimal involvement of people living with HIV and AIDS in policy formulation and no political initiatives taken for family centered approach; lack of rights approach and control program lacks planning with regard to the structural factors existing in the country. There are various factors responsible for poor access of the population groups for ART viz; social factors like lack of awareness about HIV and availability of ART; long waiting hours at the ART centers etc.

    Economic factors responsible for poor access of the population groups for ART are the costs of travelling to the clinic; shortage of doctors/paramedics for prescribing medicines, shortage of personnel/ trained counselors, shortage of testing facilities and inadequate laboratory support. Political factors leading to poor access of ART are lack of political initiative for expansion of services, submitting documents such as ration card/voter ID has been made mandatory for treatment, lack of consistency and coordination across services and the control program not reaching to the marginalized groups.

    Keywords: HIV, AIDS, High Risk Groups, Socio-Cultural Factors, Political Factors, ART, Task Shifting.

  • References

    1. National AIDS Control Organisation, Annual report 2012-13. Available at http:nacoonline.org/upload/AR%20200910/NACO_AR_English%20corrected.pdf (accessed February 18, 2014).
    2. Park K (2013). Park's Textbook of Preventive and Social medicine. Banarsidas Bahnot, Delhi, India. 22nd ed, Pg316-327
    3. Israel E, Laudari C, Simonetti C (2008) HIV Prevention among Vulnerable Populations. Pathfinder International Technical Guidance Series Number 6.
    4. Platt L, Jolley E, Rhodes T, Hope V, Latypov A, Reynolds L, Wilson D (2013) Factors mediating HIV risk among female sex workers in Europe: a systematic review and ecological analysis. BMJ Open; 3:e002836.doi:10.1136/bmjopen-2013-00283.
    5. Kral AH, Bluthenthal RN, Lorvick J, Gee L, Bacchetti P, Edlen BR (2001) Sexual transmission of HIV-1 among injection drug users in San Francisco, USA: risk-factor analysis. Lancet 357, 1397–401. http://dx.doi.org/10.1016/S0140-6736 (00)04562-1.
    6. Wood E, Schachar J, Li K, Stolltz JoA, Shannon K, Miller C, Smith EL, Tyndall MW, Kerr T (2007) Sex trade involvement is associated with elevated HIV incidence among injection drug users in Vancouver. Addict Res Theory 15, 321–5. http://dx.doi.org/10.1080/16066350701254258.
    7. Densham A (2006). Politics as a Cause and Consequence of the AIDS Pandemic. Perspectives on Politics 4, 641-46. http://dx.doi.org/10.1017/S1537592706220383.
    8. Jurgens R (2007) Taking action against HIV. A handbook for parliamentarian’s no.15. Available at www.ipu.org/pdf/publications/aids07-e.pdf (accessed on January 12, 2014).www.allianceindia.org (accessed 21st February 2014).
    9. Fox AM, Goldberg AB, Gore RJ, Bamighausen T (2011). Conceptual and methodological challenges to measuring political commitment to respond to HIV. J Int AIDS Soc 14, S5. http://dx.doi.org/10.1186/1758-2652-14-S2-S5.
    10. Hunsmann M (2012) Limits to evidence-based health policymaking: Policy hurdles to structural HIV prevention in Tanzania Social Science & Medicine doi:10.1016/j.socscimed.2012.01.023. http://dx.doi.org/10.1016/j.socscimed.2012.01.023.
    11. UNAIDS World AIDS day. Available at www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2010accessed on January 30,2014
    12. Factors affecting access to and enrolment in ART services 2012.Available at www.popcouncil.org/pdfs/events/2012ias_battala.pdf
    13. Patel S, Baxi RK, Patel SN, Golin CE, Mehta M, Bakshi H, Shingrapure K, Modi E, Coonor P, Mehta K. Perceptions regarding barriers and facilitators to combination antiretroviral therapy adherence among people living with HIV/AIDS in Gujarat, India: A qualitative study. Indian J Sex Transm Dis 2012; 33:107-11 http://dx.doi.org/10.4103/0253-7184.102119.
    14. WHO. Treat Train Retrain. Task shifting: Global recommendations and guidelines. Geneva: World Health Organization; 2007. http://data.unaids.org/pub/Manual/2007/ttrtaskshiftingen.pdf (accessed on 21st Feb 2014).
    15. Bedelu M, Ford N, Hilderbrand K, Reuter H (2007). Implementing antiretroviral therapy in rural communities: the Lusikisiki model of decentralized HIV/AIDS care. Journal of Infectious Diseases 196(Suppl 3), S464-8. http://dx.doi.org/10.1086/521114.
    16. Sherr KH, Micek MA, Gimbel SO, Gloyd SS, Hughes JP, John-Stewart GC, Manjate RM, Pfeiffer J, Weiss NS (2010). Quality of HIV care provided by non-physician clinicians and physicians in Mozambique: a retrospective cohort study. AIDS 24(Suppl. 1), S59-66. http://dx.doi.org/10.1097/01.aids.0000366083.75945.07.
    17. Assefa Y, Kiflie A, Tekle B, Mariam DH, Laga M, Van Damme W (2012). Effectiveness and acceptability of delivery of antiretroviral treatment in health centres by health officers and nurses in Ethiopia. Journal of Health Services Research & Policy 17(1), 24-9. http://dx.doi.org/10.1258/jhsrp.2011.010135.
    18. Callaghan et al. Human Resources for Health 2010, 8:8 http://www.human-resources-health.com/content/8/1/8). http://dx.doi.org/10.1186/1478-4491-8-8.
    19. Jaff ar S, Amuron B, Foster S, Birungi J, Levin J, Namara G, Nabiryo C, Ndembi N, Kyomuhangi R, Opio A, Bunnell R, Tappero JW, Mermin J, Coutinho A, Heiner Grosskurth H (2009) Rates of virological failure in patients treated in a home-based versus a facility-based HIV-care model in Jinja, southeast Uganda: a cluster-randomised equivalence trial. Lancet 374, 2080–89. http://dx.doi.org/10.1016/S0140-6736 (09)61674-3.
    20. Selke HM, Kimaiyo S, Sidle JE, Vedanthan R, Tierney WM, Shen C, Denski CD, Katschke AR, Wools-Kaloustian K. (2010). Task-shifting of antiretroviral delivery from health care workers to persons living with HIV/AIDS: clinical outcomes of a community-based program in Kenya. J Acquir Immune Defic Syndr 55, 483–90. http://dx.doi.org/10.1097/QAI.0b013e3181eb5edb.
    21. Sanne I, Orrell C, Fox MP, Conradie F, Ive P, Zeinecker J, Cornell M, Heiberg C, Ingram C, Panchia R, Rassool M, Gonin R, Stevens W, Truter H, Dehlinger M,van der Horst C, McIntyre J, Wood R; CIPRA-SA (2010) Nurse versus doctor management of HIV-infected patients receiving antiretroviral therapy (CIPRA-SA): a randomised non-inferiority trial. Lancet 376, 33–40. http://dx.doi.org/10.1016/S0140-6736 (10)60894-X.
    22. Fairall L, Bachmann M, Lombard C, Timmerman V, Uebel K, Zwarenstein M, Boulle A, Georgeu D, Colvin CJ Lewin S, Faris G, Cornick R, Draper B,Tshabalala M, Kotze E, van Vuuren C, Steyn D, Chapman R, Bateman E (2012) Task shifting of antiretroviral treatment from doctors to primary-care nurses in South Africa (STRETCH): a pragmatic, parallel, cluster-randomised trial Lancet 380, 889-98. http://dx.doi.org/10.1016/S0140-6736 (12)60730-2.
    23. USAIDS (2010).Creating an enabling environment for task shifting in HIV and AIDS services: Recommendations based on two African Country case studies. Retrieved from www.hciproject.org/communities/chw-central/resources/creating-enabling-environment-task-shifting-hiv-and-aids-services (accessed on 21February 2014).
    24. Ihuoma E, Caroline O, Irene E, Emily U, Asabe G (2010) Task Shifting -A Strategic Response to the Health Care Human Resource Crises: A Qualitative Study of Hospital Based HIV Clinics in North Central Nigeria, Office of Maryland, School of Nursing.
    25. Smith, Tamara (2010) Task-Shifting in Health Care Settings, Desk Review. Arlington, Va.: USAID | AIDSTAR-One Project, Task Order 1, 2010. Available at www.aidstar-one.com. (Accessed February 21, 2014).

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  • How to Cite

    Gupta, R., Khurana, S., & Singh, R. (2014). Progress, challenges and opportunities for HIV prevention and control among high risk groups: a public health perspective. International Journal of Medicine, 2(2), 76-80. https://doi.org/10.14419/ijm.v2i2.3564

    Received date: 2014-09-08

    Accepted date: 2014-09-28

    Published date: 2014-10-09