Dear FORUM,

Thanks to Deepak, in bringing attention to this issue. In response to his
request
(http://health.groups.yahoo.com/group/AIDS-INDIA/message/8134)

Here is a list of references that provide evidence for HIV transmission through
blood exposures in India.

1) Model-based estimates of HIV from medical injections:

Hauri AM, Armstrong GL, Hutin YJF. The global burden of disease attributable to
contaminated injections given in health care settings. Int J STD AIDS 2004; 15:
7-16.

Singhal T. Burden of HIV in India due to unsafe injections and blood
transfusions. MSc thesis submitted to University of London, 2002.

2) Studies showing blood exposures in India (other than injection drug use and
transfusions) as risks for prevalent or incident HIV infections: We are aware of
5 studies:

Solomon SS, Pulimi S, Rodriquez II, et al. Dried blood spots are an acceptable
and useful HIV surveillance tool in a remote developing world setting. Int J STD
AIDS 2000; 15: 658-661.

Chattopadhya D, Riley LW, Kumari S. Behavioural risk factors for acquisition of
HIV infection and knowledge about AIDS among male professional blood donors in
Delhi. Bull WHO 1991; 69: 319-323.

Becker ML, Reza-Paul S, Ramesh BM, Washington R, Moses S, Blanchard JF.
Association between medical injections and HIV infection in a community-based
study in India. AIDS 2005; 19: 1334-1336. (This is
from the India-Canada Collaborative HIV/AIDS Project
[ICHAP] in Karnataka.).

Reynolds SJ, Risbud AR, Shepherd ME, et al. Recent herpes simplex virus type 2
infection and the risk of human immunodeficiency virus type 1 acquisition in
India. J Infect Dis 2003; 187: 1513-1521;

Mehendale SM, Shepherd ME, Divekar AD, et al. Evidence for high prevalence &
rapid transmission of HIV among individuals attending STD clinics in Pune,
India. Indian J Med Res 1996; 104: 327-335. (Both of these reports are from a
study among STD patients in Pune.)

Panda S, Kumar MS, Lokabiraman S, et al. Risk factors for HIV infection in
injection drug users and evidence for onward transmission of HIV to their sexual
partners in Chennai, India. J Acquir Immune Defic Syndr 2005; 39: 9-15.

3) Many published studies as well as unpublished information describe nosocomial
and unexplained HIV infections in India, for example:

Singhal T. Burden of HIV in India due to unsafe injections and blood
transfusions. MSc thesis submitted to University of London, 2002.

Singh S, Dwivedi SN, Sood R, Wali JP. Hepatitis B, C and human immunodeficiency
virus infections in multiply-injected kala-azar patients in Delhi. Scand J
Infect Dis 2000; 32: 3-6.

Banerjee K, Rodrigues J, Israel Z, Kulkarni S, Thakar M. Outbreak of HIV
seropositivity among commercial plasma donors in Pune, India. Lancet 1989; ii:
166.

Singh S. Human immunodeficiency virus transmitted through sheep brain
anti-rabies vaccination. Vaccine 2003; 21: 4119.

Madhivanan P, Mothi SN, Kumarasamy N, et al. Clinical manifestations of HIV
infected children. Ind J Ped 2003; 70: 615-620.

Rogers MC, Gopalkrishnan G, Kumarasamy N, et al. HIV in couples in South India;
implications for prevention. Int J STD AIDS 2005; 16: 442-445.

Christiansen CB, Nielsen C, Machucca R. Cluster of HIV-1 infection among
children in Indian Hospital in Bombay. Informal report to World Health
Organization, September 1998. Department of Virology, Statens Serum Institute,
Copenhagen, Denmark, 1998.


These reference illustrates the lack of seriousness with which we in India have
taken this issue. The reference reports that 8 infants in a
Mumbai orphanage seroconverted during 1996-97.


Sequencing of HIV from 6 pointed to a linked outbreak. HIV transmission to these
children is suspected to have occurred during October 1996 treatment in a Mumbai
nursing home. Three children had received blood or blood products; for the
remaining 5, the reported
risks are “intravenous antibiotic treatment and routine immunization.

In countries like Romania, Russia, Poland and Kazakhstan, with fewer cases of
unexplained infections, investigations were carried out which led to unearthing
of large outbreaks, and the subsequent cleaning up of health care systems. In
the India case, as far as we are aware, absolutely nothing was done.

The only reason this was discovered was that the children were to be adopted in
Denmark.

And these are not isolated cases. During the course of our research and other
work in India, we have come across many unexplained cases (children with
HIV-negative mothers, adults with no known 'risky'
behaviours) These cases are not even reflected in our national data, leave alone
investigated.

You could also get a film on this issue, "Unheard Voices" from TISS, Mumbai.
Contact Anjali Monteiro at umctiss@...

For those who are interested in the contribution of blood exposures to
Africa’s HIV epidemics, here are two references that give opposing views, and
that provide an introduction to the ongoing debate:

Schmid et al. Transmission of HIV-1 infection in sub-Saharan Africa and effect
of elimination of unsafe injections. Lancet 2004; 363: 482-488.

Gisselquist et al. Let it be sexual: how health care transmission of AIDS in
Africa was ignored. Available at:
www.cirp.org/library/disease/HIV/gisselquist1/gisselquist1.pdf

With regards,

Mariette Correa
David Gisselquist
--
Mariette Correa
1016, Muddo
P.O. Carona
Bardez, Goa - 403523
India
Tel: 91-832-2293766
email: mariettec@...