AIDS is spreading rapidly. The very AIDS Support Group mention of AIDS provokes a picture of a person ridden with feelings of guilt and shame. There are many people who cannot bear with the idea of getting a HIV infection. They are scared to talk to anyone about it and also terrified how it will affect their family. Persons with HIV infection get terminated from their jobs and has no access to social services. But, why suffer in silence?
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Sometimes, you come across an information very late. Hence it is necessary, that a support group be formed where members can exchange information and experiences which will encourage and promote confidence and awareness.
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Behavioural change interventions to prevent sexual transmission of HIV among women and girls in resource-limited settings have had limited success, according to a systematic review published in the online edition of AIDS and Behavior.
Only eight randomised controlled trials or prospective studies with a control arm could be identified by the investigators. Moreover, only two of these programmes reduced HIV incidence. Three other interventions had an impact on HIV risk behaviours or the incidence of sexually transmitted infections.
Approximately 50% of worldwide HIV infections are in women and girls. However, the impact of HIV on women in the countries hardest hit by HIV has been more severe, with 60% of HIV infections in sub-Saharan Africa being in girls or women.
The development of female-controlled biomedical methods of HIV prevention, such as microbicides, has been slow and disappointing. Therefore HIV prevention for women and girls is reliant upon behaviour change – for example, delayed sexual debut, a reduction in the number of partners, and condom use. These methods of prevention are largely controlled by male partners, and in many cases women and girls are unable to insist on behaviour that could protect their sexual and reproductive health.
Mindful of these circumstances, an international team of investigators conducted a systematic review of behaviour change interventions to see if they reduced either HIV incidence or HIV risk behaviours.
Randomised controlled trials or prospective studies with a control arm conducted after 1990 was eligible for inclusion.
After an exhaustive literature search, the investigators were only able to identify eight studies (reported in eleven research papers) that met their inclusion criteria.
Six of the studies were conducted in Africa, one was carried out in India, and one in Mexico.
A total of 42,000 women or girls were included in these studies, and these people were followed for an average of 2.6 years.
The type of intervention varied from a single counselling session to more extensive and long-term support.
Only two interventions had an impact on HIV incidence.
The first of these was a six-month programme of group education and motivational sessions for female sex workers and brothel madams in Mumbai, India.
The intervention for the sex workers consisted of the use of motivational literature and videos, group discussions, and the use of pictorial resources focusing on HIV and condom use. The women were instructed how to use condoms correctly, and encouraged to educate their clients about condom use.
Brothel madams were educated about the economic benefits and importance of maintaining the good health of their sex workers.
HIV incidence was reduced by 67% in the intervention arm compared to the control arm. However, the investigators noted that condoms and lubricant were only provided to women in the intervention arm, and were not given to the sex workers in the control group.
This intervention was also shown to reduce the incidence of both syphilis and hepatitis B.
The second study was conducted in Uganda, and this showed that attendance at an HIV study event in the previous year reduced HIV incidence by up to 59%. Incidence of herpes simplex type-2 (HSV-2) was also reduced by 45%.
Three other interventions were successfully reduced the incidence of sexually transmitted infections, but not HIV. Condom use higher in the intervention arm in the Mexican study than in the controls (27 vs 18%, p < 0.01).
“This review has highlighted the reality that current behavior change interventions, by themselves, have been limited in their ability to control HIV infection in women and girls in low- and middle-income countries,” comment the investigators.
The investigators highlight that women and girls often have little control over their sexual and reproductive health and in many cases are unable to insist on condom use.
A “combination” approach to prevention is advocated by the study’s authors, one that addresses both behavioural and biomedical risk factors.
They write, “the diminishing hope that a single behavioral or biomedical prevention intervention will be sufficient to address the growing HIV pandemic has heralded a programmatic shift towards combination HIV prevention programming.”
Reference McCoy SI et al. Behavior change interventions to prevent HIV infection among women living in low and middle income countries: a systematic review. AIDS Behav, online edition, DOI 10. 1007/s10461-009-9644-9, 2010.
I came to know about this consultation on the Draft GIPA Guidelines through the AIDSspace platform. I have been recently diagnosed with HIV and my experiences in going through the blood banks, testing centres, and hospitals prompt me to write this response. A detailed account of what I faced can be read by visiting the link http://aidsspace.org/group/14/ and clicking on “Comments”.
Increase in social acceptance and getting rid of stigma cannot be done solely with GIPA. Education for HIV prevention and treatment through mass media is grossly inadequate. However there are several issues faced by PLHIV that should have improved, if there are effective mechanisms for GIPA. Why is it that we did not consider the experiences of PLHIV all these years in improving HIV programmes? Even after many years of its existence, the National AIDS Control Organisation (NACO) is not able to completely plug the deficits and ensure that PLHIV go through a hassle-free process in accessing services. I see a lot of NGOs, Development partners, and Networks of PLHIV on board in the Committees of NACO. I am sure they are all funded in one way or the other from various sources. However, I am not sure how far they had been successful in conveying to NACO the required information on needs and difficulties of PLHIV. As a positive person, I do not see if they have done much for PLHIV. If they have done, either it is not recognised or appreciated by the authorities, or the authorities do not have capacity or the required budget.
For me, GIPA should make difference in ensuring need-based and quality services for PHLIV. However, GIPA should not be restricted to the mere creation of some positions and jobs. And then, in the proposed Technical Advisory Group (TAG) for GIPA, there are just two members who are PLHIV. Why is it that we are not proposing the Secretary of the Technical Advisory Group (TAG) to be chosen from PLHIV? Such a move will let NACO demonstrate that there is no stigma and there is acceptance from the top hierarchy. The Draft Guidelines specifies that the technical committee meets twice or more depending on NACO’s decision. However, I feel that meetings, discussions, and debates should happen more frequently and regularly. In addition, decisions should be taken quickly and implemented. Having meetings just twice a year gives out an indication that we are not serious about GIPA.
We have already wasted opportunities over the years with the slow pace in our work. There is no denying that PLHIV will be the best to carry forward the work of NACO and other organisations. However, the question that remain is how much support and authority will they be given? The Draft says that “By involvement we mean that GIPA is meant for PLHIV and the ownership should be given to PLHIV.” Giving ownership to PLHIV will be great; though I have serious doubts. I am new to this, but I am sure there would have been voices raised by PLHIV in the past for various needs including health needs, insurance, privacy, and easy access to services. Are these voices not heard by NACO or is it because there is no support from development partners, or is it that civil society is not vocal? Such concerns need serious thinking.
The Draft GIPA Guidelines appear to be a wonderful and promising document. I hope it will not remain idle in shelves. I am optimistic and hope the finalisation and implementation based on the guidelines will bring fresh changes, and give new directions to prevent HIV, and improve the lives of PLHIV.
Person Living with HIV,
Its a much more complex process than you put it across as. DNA splicing can generate aberrations and mutations out of our control.Experimentation is the stepping stone,although jumping to enzymatic conclusions will not lead to perfection...
The motivation was survival of the human race and life on the planet.It will pave the way for phenomenal discoveries although most of the problems we face are man-made.
Last replied by Raeesa Khan on Thursday, 19 November 2009
Another response that I get from email, however I will keep the anonymity of the person:
I'm an apolitical person.
Coruption in NACO/MSACS and purchase of faulty kits doing tests are subjudis matters in the court. After the UNAIDS investigation reports the GoM/GoI have not bother to provide any records of those people who have gone through the psychological trauma of results of these tests. You should take up this issue with LAwyers Collective and file a PIL to that effect."