Author: Prof. Govindasamy Agoramoorthy
Position: Department of Pharmacy
Institution: Tajen University, Taiwan
E-mail: agoram@mail.nsysu.edu.tw
Additional Authors: Minna J. Hsu
Submitted Date: October 24, 2005
Published Date: October 24, 2005
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

The article on HIV/AIDS infection by Singh and colleagues outlines an alarming fact about the spread of this deadly virus in Nepal [1]. We would like to add that more assertive campaigns are necessary to curb the spread of infection in the Indian subcontinent before it's too late. In the year 2000 alone, a total of 5.3 million people were infected with HIV worldwide [2]. Since the epidemic started two decades ago, this immune-stripping disease has killed 22 million people globally. India, Indo-China, and the former Soviet republics have seen the most rapid raises in recent years. AIDS experts have raised alarm bells over its spread in the Asia-Pacific region and called for a united effort to control it. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates about 5 million people in India alone are infected.

The first report of HIV/AIDS infection in India was in 1986 and since then the virus has spread rapidly throughout the country. Both HIV serotypes 1 and 2 exist in India and HIV-1C is the commonest subtype reported. Sexual transmission of HIV is most predominant in India [3]. According to the Ministry of Health in New Delhi, only 3% of Indians use condoms for birth control since tradition and culture dictate that women undergo sterilisation or take pills. Prostitution plays a major role in spreading the disease among the heterosexuals in urban areas. Although Mumbai appears to be the main focus for AIDS, rapid spread has occurred in other major cities as well. The mobility of people from cities to rural areas is so rapid that the disease may already be out of control in many areas. The blood screening tests conducted at most hospitals in rural India are not adequate, making blood transfusion unsafe. The National AIDS Control Organization (NACO), the apex body for controlling AIDS in India has reported a high incidence (8.2%) of HIV positivity among healthy blood donors in urban areas [4].

AIDS is a sexually transmitted disease and as long as people are educated thoroughly and warned on the dangerous consequences of unsafe sex, there is less to fear. Unfortunately, the intervention programme launched by the NACO had very little impact in controlling the spread of the epidemic in India [4]. The current educational programmes are often restricted to the passive dissemination of information through posters, media and the display of safe-sex billboards behind automobiles. More aggressive efforts are therefore needed to reach out to every rural/urban community throughout India to combat the spread of the disease. The State and Central government agencies must build specialised shelters for the victims. More funds must be spent for effective AIDS awareness campaign, research, routine screening tests, and treatment.

According to the Asia Pacific Network of People Living with AIDS, a considerable number of people have been refused treatment, or received treatment only after delays, following a diagnosis of AIDS. Breaches of confidentiality by health workers are common in Asian countries. Within families and communities, women are discriminated against more than men, including ridicule, harassment, and physical assault, and they have often been forced to change their place of residence, due to their AIDS status [5].

Although politicians and policy makers are increasingly committing themsevles to AIDS prevention and control efforts in countries such as India, a multi-disciplinary approach is needed for effective control of the spread of this virus in the Indian subcontinent. This would include early identification and treatment of sexually transmitted diseases, promotion of condom usage, rapid blood screening for HIV in rural areas, public awareness campaigns, poverty eradication and development of prevention interventions.

Moreover, people from all walks of life must take an active role to promote AIDS awareness and prevention across the Indian subcontinent. It's time for the local and regional celebrities such as political leaders, movie stars and beauty pageants in the Indian subcontinent to involve in helping the victims and educating the public because it would certainly bring quicker awareness among the rural public. It's time to remember how the late Princes of Wales (Diana) reached out to AIDS victims, shook hands to console them and also raised millions of dollars for their welfare. Countries in the Indian subcontinent have experienced and handled deadly epidemics in the past [6] and we hope that AIDS can also be controlled and eradicated in the near future.

References
1. Singh S, Mills E, Honeyman S, Suvedi BK, Pant NP (2005) HIV in Nepal: Is the Violent Conflict Fuelling the Epidemic? PLoS Med 2: e216. DOI: 10.1371/journal. Pmed.0020216.
2. UNAIDS (2002) AIDS epidemic update. UNAIDS Geneva.
3. Godbole S, Mehendale S (2005) HIV/AIDS epidemic in India: risk factors, risk behaviour and strategies for prevention and control. Indian J Med res 121: 356-368.
4. Choudhury N, Ayagiri A, Ray VL (2000) True HIV seroprevalnce in Indian blood donors. Transfusion Med 10: 1-4.
5. Paxton S, Gonzales G, Uppakaew K, Abraham KK, Okta S, Green C, Nair KS, Merati TP, Thephthien B, Marin M, Quesada A (2005) AIDS-related discrimination in Asia. AIDS Care-Psychol Socio-Med Asp AIDS/HIV 17: 413-424.
6. Karlen A (1995) Man and microbes. Disease and plagues in history and modern times. Simon & Schuster, New York.

Govindasamy Agoramoorthy
Department of Pharmacy
Tajen University
Yanpu, Pingtung 907
Taiwan

Minna J. Hsu (hsumin@mail.nsysu.edu.tw)
Department of Biological Sciences
National Sun Yat-sen University
P.O. Box 59-157
Kaohsiung 80424
Taiwan