Magazine article UNESCO Courier

India: No Time to Lose

Magazine article UNESCO Courier

India: No Time to Lose

Article excerpt

A bold preventive education campaign brought a marked reduction in HIV incidence among Bombay prostitutes

The HIV infection made a late entry into Asia, and the continent is still a low-prevalence region for Aids. In the last few years, however, there has been an HIV explosion.

Using the parameter of "doubling time" (the time required for a twofold increase in cases) to interpret the trend of reported Aids cases to WHO during 1984-1993, the Aids scenario for Asia looks grim.

At present Aids cases in Asia are underdiagnosed, underreported and ill treated. Fear and ignorance are compounding the difficulty of controlling the spread of the virus. In most places there are no protocols to follow up HIV-infected people: counselling, outpatient or inpatient care services are far from developed, not to mention prenatal HIV screening. Even today, most health care professionals refuse to treat patients with HIV/Aids and, unfortunately, even the international scientific community and major donors delayed giving their attention to Asia.

Despite the growth of HIV/Aids in Asia, there has been no major focus on the problem by political leaders. In Zambia, when the then President Kenneth Kaunda's son died of Aids, he publicly pledged support to Aids control programmes, justifying his action as the best possible homage to his departed son. All too often, Asian heads of state regard Aids as too insignificant an issue to be treated as a priority.

The sexual mode of HIV transmission predominates in most Asian countries, and commercial sex workers (CSWs) and their clients play an important role in the pandemic. In recent years the increase in infection in CSWs in Thailand, India, Cambodia and Nepal has been dramatic.

Project Saheli: Aids prevention through peer education

During 1987, when a fairly high prevalence of HIV was noticed in Nairobi CSWs, the Indian Health Organization (IHO) warned that if the Aids threat was not taken seriously, Bombay and other Asian cities would face the Kenyan capital's fate. The warning was widely ignored.

Since then the IHO has developed a peer education programme for sex workers in Bombay which has reduced HIV incidence and widened the doubling time from eight months in 1988 to four years in 1993. Known as "Project Saheli", the campaign reaches out to 10,000 CSWs through 350 peer leaders and distributes 1 million condoms every month in Bombay and four other cities. It has no sustained funding.

After evaluating various approaches for condom promotion such as social marketing and door-to-door vending, we opted for the "peer education" model for our work among CSWs. …

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