Thursday 14 June 2012

HIV/AIDS in India and UNICEF in Action


The National AIDS Control Programme (NACP) III 2007-2012 has the overall goal of halting and reversing the epidemic in India. Over 99 per cent of the population in the country is free from infection. NACP III places highest priority on prevention while seeking to integrate care, support and treatment for those affected by HIV/ AIDS. 

Fast Facts
Global, Regional & India Estimates
• An estimated 33.4 million people worldwide were living with HIV (2008).
• Approximately 2.1 million children under 15 were living with HIV (2007).
• An estimated 2.1 million people died of AIDS-related causes (2007).
• An estimated 290,000 children under 15 died of AIDS-related causes (2007)
• India has a low HIV prevalence of 0.34 per cent. Yet in terms of individuals infected, India is home to the third largest number of people living with HIV in the world.
• The vast majority of HIV infections in India occur through sexual transmission (85.6 per cent).
• Nearly five per cent of infections are attributable to parent-to-child transmission.
• The epidemic disproportionately affects women, who account for 40 per cent of the total infections in the country.
• In India, the epidemic is more pronounced in urban areas than rural ones and decreases with increasing education levels.
Key Issues
The Four Ps:
The global and country level response to HIV is based on a comprehensive approach that includes the following four strategic elements, or the four P’s:
• Preventing HIV transmission from women living with HIV to their infants.
• Primary prevention of HIV infection among couples of child bearing age.
• Preventing unintended pregnancies among women living with HIV.
• Providing appropriate protection to children affected by HIV and their families.

Prevention of parent-to-child transmission (PPTCT)
  • In India, the transmission of the virus from the mother-to-child during pregnancy, labour and delivery or breastfeeding is called parent-to-child-transmission to emphasize the role of the father in both the transmission of the virus and management of the infected mother and child.
  • Nearly five per cent of infections are attributable to parent-to-child-transmission.
  • It is estimated that out of 27 million pregnancies every year, nearly 49,000 occur in HIV-positive mothers.
  • The number of facilities offering HIV testing and counseling went up from 4,269 in 2007 to 4,817 in 2008 and stands at 4,987 as of March 2009. As of December 2008, only 16 per cent of pregnant women were tested for HIV, while 22 per cent of the children born to the estimated 49,000 HIV-positive women were receiving anti retroviral prophylaxis.
  • In 2009, only 11489 of an estimated 49,000 pregnant women living with HIV received anti-retroviral treatment to prevent parent-to-child transmission. This is because of multiple factors including social customs, lack of family support and financial barriers, which constrain women from availing of institutional care necessary for administering treatment.  PPTCT services have also not been scaled up in remote areas with lower HIV prevalence.
  • One of the best practices in PPTCT in India is the outreach approach, used by the ICTC to ensure that HIV-positive women who are tested are followed up before, during and after an institutional delivery, and provided with anti-retroviral prophylaxis.
  • The core principle of this approach rests on the continuum of care for women, children and their families – a chain of interventions that begin before pregnancy and continue through pregnancy, labour and delivery and subsequently as part of routine or specialized chronic care services for after the child is born.
Pediatric care and treatment:
  • It is estimated that 70,000 children below the age of 15 are living with HIV in India and 21,000 children are infected every year through parent-to-child transmission. A small proportion are also infected by unsafe injections and infected by blood transfusions.
  • Most children are infected with the virus while still in the womb, during birth or while breastfeeding.
  • The National Pediatric Antiretroviral Treatment (ART) Initiative was launched in 2006. A total of 40,000 children living with HIV will be provided ART by the end of NACP-III.
  • A total of 375 ART centres shall be equipped to offer pediatric ART in the country.
  • Follow up of HIV exposed infants, according to the Indian Guidelines, begins at six weeks. The ‘Road to Health’ card for these children includes information on maternal HIV status, co-trimoxazole prophylaxis, infant HIV diagnosis and infant feeding information.
  • To reach more mother-infant pairs, the Reproductive and Child Health (RCH) programme is linked to the PPTCT and Pediatric HIV programme in order to provide for and incorporate HIV care into the package of services for mothers and children.


Preventing infection among young adolescents and young people:
  • In India, the prevalence of HIV among 15-19-year-olds is 0.04 per cent and that among 20-24 year olds is 0.18 per cent
  • By the end of the NACP III, about 25 million students will have been reached through the Adolescent Education Programme
  • The NACP III will also bring HIV prevention skills education programmes and related services to 70 million young people who are not in school, including, street children, children of CSWs, children in institutions, child labourers and other vulnerable youth.
Protection, care and support for children affected by AIDS:
  • In the short term, NACP III will reach out to as many children living with HIV as possible to provide them with the treatment and the care and support services that they need. 
  • In the long term, NACP III aims to ensure that every child has access to the same comprehensive set of basic health, education and social protection services, regardless of their HIV status or that of any member of their family.
UNICEF in Action
UNICEF supports the Government in its effort to halt & reverse the HIV/AIDS epidemic in India, and mitigate its impact on affected children and women.
UNICEF is assisting the government to further expand and enhance the quality of programmes to reduce the transmission of HIV from infected mothers to their children and to increase the access of these mothers and their children to treatment in various ways: by providing strategic supplies of drugs and commodities, improving the capacity of staff; by developing innovative communication approaches for prevention and care; helping to improve monitoring and reporting systems.
UNICEF supports efforts to reduce stigma and discrimination against children and people affected by HIV and for commitment on ensuring their equal access to essential health, social welfare and educational services.
UNICEF’s program contributes to increasing knowledge, dispelling myths and misconceptions relating to HIV transmission and prevention behaviors among vulnerable young people.
Source: UNICEF

Tuesday 12 June 2012

Face to face with chronic disease: Hearing Impairment


Face to face with Hearing Impairment
Six year old Marinah Solonirina lives in Ambohimangakely village, Madagascar. She is about to visit an ear clinic with her mother and two sisters, to have her ears examined and her hearing tested.


 The clinics – like the one shown in this photo – were set up and run as part of a broader survey of the prevalence of hearing impairment. Teams of health workers, with support from WHO and the Christoffel-Blindenmission (an international NGO), have set these up in remote areas.
The main purpose of the clinics is to diagnose and manage hearing problems early. Half of all hearing loss can be prevented if caught early enough.
Testing is quick and inexpensive. When problems are identified early, they are usually more straightforward to treat.
At the clinic, health workers carry out a hearing test and an ear examination on Marinah. They find a potentially serious middle ear infection in one ear.

Testing consists of checking hearing levels using headphones which play tones at different pitches and volumes as well as visual examination of the eardrum and middle ear.

The health workers prescribe a course of antibiotics and instruct Marinah's mother in personal hygiene for her ears. Through inexpensive, simple and early intervention, serious damage to Marinah's hearing was prevented.

More than one million men, women and children in Madagascar are affected by moderate to profound hearing loss. In children, most hearing loss is caused by ear infections, many of which go untreated and often lead to serious hearing problems.
With few doctors or nurses available, health workers from the clinic train teachers from the local school to help find and test children for possible hearing loss.
Teachers can also be trained to help hearing-impaired children with their speech. A special clinic in a nearby city helps with speech and language development.
In Marinah's village, Ambohimangakely, the village chief encouraged local people to come for hearing tests at the mobile clinic.
The goal of WHO and partners is to set up training for primary ear and hearing care for health workers in clinics in remote areas so that many more people in Madagascar will be spared a lifetime of hearing loss and deafness.
Source: WHO

Face to face with chronic disease: Cataract

Kuzhanthiammal's story: the gift of sight 


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Kuzhanthiammal began to worry two years ago when a white film started to cloud one of her eyes. Her sight rapidly deteriorated, making it hard to work on her land and take care of her family. The nearest hospital was too far away and too expensive to visit.




Soon after her symptoms appeared, Kuzhanthiammal heard that a mobile diagnostic eye clinic was visiting a nearby village. The clinic is run by the Aravind Eye Hospital in Madurai, India, to reach people living in remote, rural villages. Kuzhanthiammal went to the clinic, and within a few minutes, she was diagnosed with cataract.

The clinic staff registered Kuzhanthiammal for free cataract surgery the following week at the hospital. The programme also covered transportation costs. "A bus picked me up with seven other people and drove us to the hospital," she says. Around 70% of patients at the hospital receive free eye surgery and follow-up care. They are subsidized by the 30% who are able to pay for their medical care. The hospital also produces and sells lenses to help pay for its services.
Now 67 years old, Kuzhanthiammal successfully underwent surgery on her other eye a few months ago. "The operation was over so quickly. It's a miracle — it's like waking up with your problems gone."



Cataract is the leading cause of blindness in the world. Thanks to the innovative work of hospitals like Aravind, people who have limited access to health care are receiving sight-saving interventions that wouldn't otherwise be available.







Source:  WHO