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Dear FORUM,

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/7075

Enquiry Report of Kerala SACS of Benson &  Bency

"As of now a total of Rs.2,45000/- has been allotted and Rs.2,17,078/- expended.
Balance Rs.27,922/- is with DMO, Kollam."

Visited the home of Bency & Benson at Kaithakuzhy, Chathannoor, Kollam District
on 21-03-2007 at 08.30 A.M. reporting the following points for your kind
information

Bency – 12 Year, Benson – 10 Years now studying in Kaithakuzhy Government UP
School.  Their father Sri C K Chandy died in 1997, mother Smt.Mary Chandy
(Princy) died in 2000 and grandfather Sri.Geevarghese Johny died on 11-01-2005. 
Now the children are under the care of their grandmother Smt. Salamma John, who
is the only caretaker of these children at present.  She is suffering from
visual impairment.

Smt.Salamma John is getting family pension of Rs.1,500/- per month.  They are
also getting another Rs.1,500/- per month in the way of interest of the amount
credited in SBT, Chathanoor.  Ex MLA is also sending Rs.500/- per month from
October 2005 as a supporting fund.

Care and Support from Government, KSACS

As per the instruction of the then Central Health Minister, Hindustan Latex
Limited is allotting Rs.30,000/- in every 6 months, from February 2004 onwards
through KSACS,  and DMO, Kollam is devolving the funds.  As of now a total of
Rs.2,45000/- has been allotted and Rs.2,17,078/- expended.  Balance Rs.27,922/-
is with DMO, Kollam.

The fund is used for

1) Purchase of Medicines, Tonics etc. (When not available from Government
Pharmacy)
2) Provision of Milk, Egg, Ghee, Horlicks/Boost etc.
3) Diesel charges of the Government Vehicle for the transportation of Children
to PH Lab, SAT, ART at Medical College Hospital, Trivandrum
4) Transportation charges in the case of emergencies to Hospitals.

Medical Officer, Jr Health Inspector and other staff of P H Centre Adichanalloor
assigned with the responsibility of the Care and Support related their health,
treatment, medicines, nutrition etc.  DMO, Kollam is supervising all the
activities as per the instructions of KSACS.    Medicines are provided from ART
Center, Trivandrum  as per the regime.

Support from the St Thomas Church, Kaithakuzhy

1) Transportation of the children to the school in Autorickshaw purchased by the
Women’s Wing, St Thomas Church. (As per the request of DMO, Kollam)
2)Stationery items like Rice, Sugar, Tea, etc. as per the list of the
grandmother.
3)Religious support, counseling, study in Sunday school etc.

A church committee also formed with Mr Raju Thomas, Vicar of the St Thomas
Church, Kaithkuzhy for extending all sorts of ground support to them.

We also had a discussion with the Vicar Fr Raju Thomas about the complaint of
the grandmother that the vicar and the middlemen are evading financial aids to
these children from other sources.  The Vicar presented a detailed account of
the amount received and expended in this connection and were found to be
convincing.

At present the general health of the children is satisfactory as per the Lab
checkup reports and Doctor’s report.  Health services staff also providing
satisfactory service.

Problems they are facing and Requirements.

1)Shortage of fund for their day to day expenses like Electricity, Telephone
Charges, Dress, Food, Tuition etc.
2) Pravur SNV Co-operative Bank, Kollam has send a ‘Japthi Notice’ for remitting
Rs.90,000/- (Principal + interest) of a loan availed in 2004.  Now they are
helpless in the repayment.
3) Due to the court decision regarding the assignment of Guardianship to the
grandmother, court credited the amount Rs.1,00,000/- for 10 years.  Only
Rs.750/- per month being the interest of the Deposit is enjoyed by them.
4) Due to the ageing and other health problems faced by the grandmother, they
actually require a Home Nurse/Servant.

Media can create problems, they do not want solutions

Please note that, about 5000 Similar Childrens in Kerala and face lot of 
problems. We have to develop a good mechanism to overcome this.

Regards

Ajith Kumar M
Finance Officer
Kerala State Aids Control Society
009447168748
e-mail: <ajith_karamana@...>

Two Delhi hospitals under scanner for HIV transmission

New Delhi, March 29: The capital's two top state-run hospitals came
under scanner after two patients allegedly were infected by HIV after
blood transfusion. While the All India Institute of Medical Sciences
(AIIMS) has denied the charge, a court here asked the Safdarjung
Hospital to provide free treatment to the infected patient.

The family of a 17-year-old girl Wednesday alleged that she died
Monday from HIV-related complications after blood transfusion at the
AIIMS.

Yogesh Chauhan, father of the deceased girl, Jyoti, alleged that she
contracted HIV after contaminated blood transfusion during her
treatment at the AIIMS for dengue fever in November 2006.

"It is complete negligence on the part of AIIMS, which gave her the
infected blood," Chauhan, an auto-driver, told media persons.

However, AIIMS Medical Superintendent D.K. Sharma said, "There is
zero chance of HIV infection at AIIMS. We have all the facilities and
blood transfusion at our institute is 100 percent reliable.

"It's a misinformed campaign."

AIIMS clarified that Jyoti was admitted to the hospital on Nov 2,
2006, through the casualty ward. "The girl tested HIV positive during
her treatment on Nov 4 and it was conveyed to the family," Sharma
added.

"At that time, she had loose motions, pain in the abdomen, blood in
her stools and vomiting with a history of having received
tuberculosis treatment in 2005-06," AIIMS chief spokesman Shakti
Gupta said.

"During the course of investigations, since she was suffering from
the Crohn's disease which is associated with immune system
dysfunction, her blood was tested for HIV (1+2) anti-bodies on Nov 4
and she was found to be HIV positive," he said.

The patient was again admitted March 11 with symptoms of respiratory
distress under the department of medicine.

"Two days later she was shifted to the intensive care unit. She died
on March 26 with the cause of death being Acute Respiratory Distress
Syndrome with sepsis with refractory shock with bilateral severe
pneumonia with HIV(+)," Gupta added.

He said it is evident that the patient was HIV positive at the time
of her initial hospitalisation in November even before the platelet
transfusion was given to her due to dengue.

"In the hospital blood bank, all blood and blood products are being
tested for all infectious markers as per guidelines of the National
Blood Transfusion Council, including HIV.

"P-24 antigen testing is done, which is a very sensitive test and
therefore it is not practically possible for anyone to get HIV
infection through transfusion of blood or platelets from AIIMS," he
added.

Meanwhile, a similar case turned up before the Delhi High Court
Wednesday that directed the government to bear the cost of treatment
of a child, who was allegedly inflicted with HIV after blood
transfusion in the Safdarjung Hospital.

While disposing of the petition with the directions, Justice B.D.
Ahmed said: "The government should bear all expenses including for
the treatment of the patient."

Naseem Ahmed, a resident of a village near Ranchi in Jharkhand, had
filed a petition seeking direction to the government for free
treatment and to meet other expenses of his nine-year-old child,
Faizan, who had been under treatment for the past five years.

Ahmed's counsel Sugriv Dubey said in his petition that Faizan was
being treated at a Ranchi hospital for anaemia. He was referred to
the AIIMS here for further treatment in 2002.

The AIIMS, however, had refused to treat him and sent him to the
Safdarjung Hospital across the road.

The petition alleged that the child was given HIV-infected blood
without scanning the same during the blood transfusion in the
hospital.

Authorities, however, deny the allegation saying that the hospital
had a proper mechanism to scan the blood given to patients.

Bureau Report

http://www.zeenews.com/znnew/articles.asp?rep=2&aid=362689&sid=NAT

Sir,

I have few doses of Enfuviritide, donated by one of my patient. If
anybody is taking this injection, i can send the medicines to him/her.
It is free.

Dr.Manoharan.
E-MAIL: <argusmano@...>

Dear All

The Online Counseling facility and Resource Center under UNDP TAHA Project in
Bihar got a new impetus with the Launch of toll free Helpline 1800 180 1000. The
number has been installed with Bihar Network of People Living with HIV/AIDS
Society (BNP+) at Patna. This center will receive calls from all over Bihar and
its neighboring areas. It will cater to the need of callers regarding Legal
Counseling, Information on HIV/AIDS, Preventive measures etc.

After inaugurating the said Helpline number on 27th March at local Patna Hotel
Maharaja Inn the Honorable Speaker, Bihar Assembly, Shri Uday Narain Chaudhary
said it was need of hour to start a service like this. He also cited migration
and decline of social values/norms as the main reason for the spread of virus in
the state. He applauded the activities of TAHA Project in Bihar. About 25 Media
Persons from different print and electronic media were also present. A through
discussion on TAHA activities and the role of BNP+ took place on the occasion.
Unveiling the activities and strategies of UNDP in Bihar the State Project Team
praised the efforts of BNP+ and its board members, especially Mr. Rajnish Singh
who is President of BNP+.

Officials from Bihar State AIDS Control Society also shared their views on the
occasion and praised the efforts made by UNDP TAHA to launch this service

Mr. Rajnish informed that now BNP+ has 1600 members within their network. He
also informed about the livelihood related activities of BNP+ running in Bihar
with the technical & financial support of UNDP TAHA Project. Till date BNP+ has
benefited PLWHA and its dependents by arranging either jobs or PCO, agentship of
life insurance, etc, under the guidance of Mr. Rajnish Singh.

Looking forward for support to strengthen the mission.

Niraj Kumar
e-mail: <nirajk2in@...>

Dear Forum,

Greetings from Positive Lives Goa "PLG" !

As a part of networking and advocacy effort of Positive Lives Foundation “PLF –
Goa organized a community event through networking to promote a human rights
issues of PLHAs and create"Positive Prevention Massages, an Image"  in
Collaboration with local Mahila Mandal, on Sunday, 25th March 2007, 3.p.m to
7.p.m, at Pratap Nagar, Dharbandora, Usgoa Tisker, Ponda Goa.

Welcome session chaired with brief note of the program by Mrs. Nirmala Rewanker,
Social Worker and President of Mahila Mandal.

Introduced Mr. Jaffer Inamdar, Program Manager / Founder President of Positive
Lives Foundation “PLF – Goa” gave a talk on HIV / AIDS / STIs, Positive Living
with HIV, as a Positive Speaker share his own experience to sensitize community
on issues of People Living with HIV/AIDS, being HIV+ve body for the past 12
years leading happy and healthy life devoid of medication. How community treated
him when publicly disclosed his status by coming out openly first time in Goa in
2001 and negative attitude of the community concerning to PLHAs.

As well as highlighted how women’s are becoming infected from their husband in
India. He also stressed to take protective and preventive measures from becoming
infected with HIV Virus, by empowering those women’s and individual
responsibilities fighting HIV/AIDS, treating HIV Positive People with respect
and dignity.


Adv. Sitaram R. Singal B.Sc. LLB Chief Guest of the function gave a speech on
important of HIV AIDS as a social and development issues and to tackle a
seriously preventing spread of HIV/AIDS in Goa. Also reveal to the community to
give information to others what Jaffer shared and his example

Mr. Govind Vithal Sawant Congress Member and South Goa Zilla Panchayat, guest of
hounor presented on women’s empowerment and how women’s can prevent HIV/AIDS.

  Mr. Vinay Tendulker BJP member Special Guest given a speech on Women’s Power in
the community fighting HIV Virus.

Mrs. Sakuntala Bola Goanker member of Mahila Mandal were guest of honor present
on the occasion. Mr. Nitin Rewanker well wisher of the community given a vote of
thanks to all audience and guest.

Nearly 300 local community people participated in the program majority audience
was women’s; teen age Children’s and mans was also part of the program. Response
was very good educating community at the grass root level. This community people
belong to labour catagery practicing unsafe sexual behavior they may be positive
but do not know they status. Mostly migrated from Maharashtra, Karnataka, Kerla
and others part of neighboring states for they daily living. Our few PLHAs
members are from same area.

FIGHTING STIGMA & DISCRIMINATION
Concluded with feedback from the community their said, before they do not know
anything about HIV/AIDS and never seen any HIV positive person before, when they
saw Jaffer they shocked could not believe that HIV positive can too live normal
healthy life. Even people contacted him personally for further more information,
HIV testing and also to discuss about they health condition and problems. It was
reduced Myth and Misconception about HIVAIDS and increases the visibility of
PLHA among general community to better response to HIV epidemic in Goa through
personal testimony. Furthermore, briefed about Drop – In - Centre of PLF-Goa and
its services as a helpline for HIV positive people in Goa.

Therefore, we would like to intimate you that we have been change our
organisation name from “Positive Lives Foundation “PLF” to Positive Lives Goa
(PLG).

For further references “Positive Lives Goa “PLG”.

Warm regards
Sincerely

Famida Shaikh
Program Assistant
POSITIVE LIVES GOA “PLG”
                    &
PLG POSITIVE WOMEN FORUM IN GOA
***************************************************************
POSITIVE LIVES GOA “PLG”
AP/41, G.2., C.P. Villa, Opp. Petrol Pump,
Near Sriram Super Market, Green View Appt,
Betim Road, Alto Porvorim, Goa - 403521
Phone: 91 – 832 – 2415389
Mobile: 9371186773
Email: plfgoa@... /  plf@...
****************************************************************

EngenderHealth India, had organized a national dissemination of the key learning
and recommendations from three innovative pilot projects
supported by DFID on 28th March, 2007, India International Centre, New
Delhi. Ms. Sujatha Rao, Director General, National AIDS Control
Organisation was  the Chief Guest and she launched training materials,
films, and digital stories produced among the course of the three
one-year projects. Ms. Silke Seco Health Advisor, DFID delivered the key note
address. The project partners from Uttar Pradesh, Gujarat, kerala, Karnataka and
Andhra Pradesh participated along with members from State AIDS Control
Societies, bilateral organizations, International and national NGOs, people
living with HIV and members of the media.

a. Reducing HIV/AIDS Stigma and Discrimination in Health Care Settings
in Kerala: A rights-based Approach. The project partnered with Kerala
State AIDS Control Society( KSACS) and Networks of people living with
HIV.

b. Making a Difference in Women's Lives by Engaging Men Living with
HIV As Partners In Positive Prevention in Gujarat & Uttar Pradesh. The
project partners are Gujarat State Network for People Living with HIV(
GSNP+)), Gujarat State AIDS Control Society(GSACS), Uttar Pradesh
Welfare for People living with HIV Society( UPNP+) and the Uttar Pradesh State
AIDS Control Society(UPSACS).

c. A right to care: Rights-Based Approach to Sexual and Reproductive
Health for Women

Living with HIV/AIDS in India in Andhra Pradesh and Karnataka. The
project partners are Mediciti , Swami Vivekananda Youth Movement (SVYM),
Positive Women Network(PWN+) , Karnataka state AIDS Control
Society(KSACS) and Andhra Pradesh State AIDS Control Society(APSACS).

The following training and advocacy materials produced through these
projects were disseminated at the meeting.

* Men As Partners® in Positive Prevention -Training tool for
training Men Living with HIV as MAP advocates available in English,
Gujarati and Hindi
* `The Positive Way' – life stories of six men - digital stories from Uttar
Pradesh and Gujarat
* `Men Today, Men Tomorrow' – a short film
*  Sexual and Reproductive Health for HIV positive women and
adolescent girls – A training manual available in English, Kannada
and Telugu
* Reducing Stigma and Discrimination in Health Care Settings- A
Trainers Guide for training health service providers, English
* `The Act of the Second God' – a film on reducing stigma discrimination
* `It is my life' –a film produced by Positive Women Network

We will post the key learning and recommendation from each of the three pilot
projects shortly.

Please contact us for these materials

Geetha Venugopal
Program Associate
EngenderHealth
India Country Office
F6/8 Poorvi Marg
Vasant Vihar, New Delhi -110057
Tel 91-11-26147123
e-mail: <geethavenugopal1@...>

[Moderators note: WHO/UNAIDS Technical Consultation Male Circumcision
and HIV Prevention: Research Implications for Policy and Programming
Montreux, 6- 8 March 2007. Conclusions and Recommendations is
available from the following url.
http://www.who.int/hiv/mediacentre/MCrecommendations_en.pdf ]
_____________________
WHO and UNAIDS announce recommendations from expert consultation on
male circumcision for HIV prevention

PARIS/GENEVA, 28 MARCH 2007 -- In response to the urgent need to
reduce the number of new HIV infections globally, the World Health
Organization (WHO) and the UNAIDS Secretariat convened an
international expert consultation to determine whether male
circumcision should be recommended for the prevention of HIV
infection.

Based on the evidence presented, which was considered to be
compelling, experts attending the consultation recommended that male
circumcision now be recognized as an additional important
intervention to reduce the risk of heterosexually acquired HIV
infection in men. The international consultation, which was held from
6-8 March 2007 in Montreux, Switzerland, was attended by participants
representing a wide range of stakeholders, including governments,
civil society, researchers, human rights and women's health
advocates, young people, funding agencies and implementing partners.

"The recommendations represent a significant step forward in HIV
prevention", said Dr Kevin De Cock, Director, HIV/AIDS Department,
World Health Organization. "Countries with high rates of heterosexual
HIV infection and low rates of male circumcision now have an
additional intervention which can reduce the risk of HIV infection in
heterosexual men. Scaling up male circumcision in such countries will
result in immediate benefit to individuals. However, it will be a
number of years before we can expect to see an impact on the epidemic
from such investment."

There is now strong evidence from three randomized controlled trials
undertaken in Kisumu, Kenya, Rakai District, Uganda (funded by the US
National Institutes of Health) and Orange Farm, South Africa (funded
by the French National Agency for Research on AIDS) that male
circumcision reduces the risk of heterosexually acquired HIV
infection in men by approximately 60%. This evidence supports the
findings of numerous observational studies that have also suggested
that the geographical correlation long described between lower HIV
prevalence and high rates of male circumcision in some countries in
Africa, and more recently elsewhere, is, at least in part, a causal
association. Currently, an estimated 665 million men, or 30 % of men
worldwide, are estimated to be circumcised.

Male circumcision should be part of a comprehensive HIV prevention
package

Male circumcision should always be considered as part of a
comprehensive HIV prevention package, which includes the provision of
HIV testing and counselling services; treatment for sexually
transmitted infections; the promotion of safer sex practices; and the
provision of male and female condoms and promotion of their correct
and consistent use.

Counselling of men and their sexual partners is necessary to prevent
them from developing a false sense of security and engaging in high-
risk behaviours that could undermine the partial protection provided
by male circumcision. Furthermore, male circumcision service
provision was seen as a major opportunity to address the frequently
neglected sexual health needs of men.

"Being able to recommend an additional HIV prevention method is a
significant step towards getting ahead of this epidemic," said
Catherine Hankins, Associate Director, Department of Policy, Evidence
and Partnerships at UNAIDS. "However, we must be clear: male
circumcision does not provide complete protection against HIV. Men
and women who consider male circumcision as an HIV preventive method
must continue to use other forms of protection such as male and
female condoms, delaying sexual debut and reducing the number of
sexual partners."

Health services need strengthening to provide quality services safely
Health services in many developing countries are weak and there is a
shortage of skilled health professionals. There is a need, therefore,
to ensure that male circumcision services for HIV prevention do not
unduly disrupt other health care programmes, including other HIV/AIDS
interventions. In order to both maximize the opportunity afforded by
male circumcision and ensure longer-term sustainability of services,
male circumcision should, wherever possible, be integrated with other
services.

The risks involved in male circumcision are generally low, but can be
serious if circumcision is undertaken in unhygienic settings by
poorly trained providers or with inadequate instruments. Wherever
male circumcision services are offered, therefore, training and
certification of providers, as well as careful monitoring and
evaluation of programmes, will be necessary to ensure that these meet
their objectives and that quality services are provided safely in
sanitary settings, with adequate equipment and with appropriate
counselling and other services.

Male circumcision has strong cultural connotations implying the need
also to deliver services in a manner that is culturally sensitive and
that minimizes any stigma that might be associated with circumcision
status. Countries should ensure that male circumcision is provided
with full adherence to medical ethics and human rights principles,
including informed consent, confidentiality, and absence of coercion.

Maximizing the public health benefit

A significant public health impact is likely to occur most rapidly if
male circumcision services are first provided where the incidence of
heterosexually acquired HIV infection is high. It was therefore
recommended that countries with high prevalence, generalized
heterosexual HIV epidemics that currently have low rates of male
circumcision consider urgently scaling up access to male circumcision
services. A more rapid public health benefit will be achieved if age
groups at highest risk of acquiring HIV are prioritized, although
providing male circumcision services to younger age groups will also
have public health impact over the longer term. Modeling studies
suggest that male circumcision in sub-Saharan Africa could prevent
5.7 million new cases of HIV infection and 3 million deaths over 20
years.

Experts at the meeting agreed that the cost-effectiveness of male
circumcision is acceptable for an HIV prevention measure and that, in
view of the large potential public health benefit of expanding male
circumcision services, countries should also consider providing the
services free of charge or at the lowest possible cost to the client,
as for other essential services.

In countries where the HIV epidemic is concentrated in specific
population groups such as sex workers, injecting drug users or men
who have sex with men, there would be limited public health impact
from promoting male circumcision in the general population. However,
there may be an individual benefit for men at high risk of
heterosexually acquired HIV infection.

More research needed to further inform programme development

Experts at the meeting identified a number of areas where additional
research is required to inform the further development of male
circumcision programmes. These included the impact of male
circumcision on sexual transmission from HIV-infected men to women,
the impact of male circumcision on the health of women for reasons
other than HIV transmission (e.g. lessened rates of cancer of the
cervix), the risks and benefits of male circumcision for HIV-positive
men, the protective benefit of male circumcision in the case of
insertive partners engaging in homosexual or heterosexual anal
intercourse, and research into the resources needed for, and most
effective ways, to expand quality male circumcision services.

Research to determine whether there are modifications in perceptions
and HIV risk behaviour over the longer term in men who are
circumcised for HIV prevention, and in their communities, will also
be essential.
http://www.who.int/hiv/mediacentre/news68/en/index.html

The Novartis appeal resumed today.  Shanti Bhushan continued his argumentthat
the ¦Â-crystalline form of imatinib mesylate resulted in an enhanced efficacy
over the free base.  He pointed to the study conducted by Novartis on rats that
allegedly showed a 30% increase in bioavailability of ¦Â-crystal form of
imatinib mesylate over the free base.  At this point, J. Balasubramaniam
observed that this study had been conducted on rats.  He asked what conclusions
we could draw from a study conducted on rats.

Bhushan replied that rats, humans, and monkeys are warm-blooded animals, and
that one could assume that an increased bioavailability in rats could also have
a similar effect on humans.

Bhushan argued that the compound described in the current patent application
represented a two-step improvement over the prior art:
1. The selection of the mesylate salt amongst what he alleged were "thousands"
of possible salts disclosed in the 1993 patent (US 5,521,184) that had claimed
imatinib and "all pharmaceutically acceptable salts thereof"; and 2. The
creation of the ¦Â-crystalline form of the mesylate salt.  He pointed out that
the generic companies were free to manufacture any of the "thousands and
thousands" of
other possible salts; and that it was indicative of Novartis' inventiveness that
all other generic companies only wanted to copy this particular form of
imatinib.

In attempting to distinguish between incremental innovation and
evergreening, Bhushan claimed that if a salt form did not improve the drug, then
it would admittedly be evergreening, but where a salt did improve the drug, then
it could not be considered evergreening.

Bhushan then cited to a series of cases (the table of cases cited will be made
available on our website) relating to selection patents to argue that Novartis'
selection of the mesylate salt, with its specially beneficial properties, from
"tens of thousands" of possible salts.  Bhushan argued that the essential
holding of these cases was that where a prior art reference discloses a large
number of possible permutations, an applicant who was able to identify a
sub-class of these that possess a characteristic that was "significantly more
advantageous" than the others was entitled to a selection patent.

At this point, J. Sridevan asked whether the requirement of showing
significant advantageousness was similar to showing a significant
enhancement of efficacy under section 3(d).  J. Sridevan asked Bhushan
whether if selection patents are allowed, wouldn't 3(d) be equally valid? To
this, Bhushan replied in the affirmative.

Bhushan then introduced some documents: an article on solid state
pharmaceutical chemistry and two entries printed from the Wikipedia website, to
show the steps in drug development and to show the complexities involved in salt
selection and polymorph discovery.  At this point, several counsel objected to
Bhushan's reliance on Wikipedia.

Bhushan then read the relevant portions from the Indian application to show the
potential use of imatinib to treat various disorders, including CML, restenosis,
and thrombosis.  He also read the portion in the Indian application that states:
"It goes without saying that the indicated inhibitory and pharmacological
effects are also found in the free base¡Äor other salts thereof."  He further
read the portion which admitted that the activity of the mesylate salt was
described in a 1996 publication.

He then went through the USPTO prosecution history and pointed out that in the
USPTO as well, the patent examiner had initially rejected the subject
application on the grounds of anticipation and obviousness.  He pointed out that
the USPTO Appeals Board reversed the patent examiner's rejection, holding that
the patent examiner had not relied on any data to show that the 1993 patent
"inherently disclosed" the ¦Â-crystalline mesylate salt.


In response to test data that Natco had submitted during the pre-grant
opposition phase which showed that the ¦Â-crystalline form was inherently formed
when the mesylate salt was prepared, Bhushan attempted to introduce an expert
affidavit dated April 2006, four months after the Patent Controller's Order.  At
this point, Grover objected on the grounds that under the Indian Code of Civil
Procedure, Novartis could not introduce evidence that was not before the Patent
Controller unless it could show that despite due diligence, it could not have
made such evidence available to the
Patent Controller.  Grover argued that Novartis had ample opportunity to, and in
fact did, reply to the tests that Natco had submitted, and that Novartis was now
barred from introducing new facts before the Court.  The justices replied that
the objections had been noted and that the respondents could argue this at the
time of response.

Bhushan then took the Court through the data submitted by Natco, which were
submitted by two reputed institutes:  the Indian Institute of Technology (Delhi)
and the Indian Institute of Chemical Technology (Hyderabad), which had confirmed
that in making the mesylate salt of imatinib in a variety of conditions, the
¦Â-crystal form was invariably produced.  Bhusan claimed that this data was
entirely irrelevant, as Natco had allegedly supplied the institutes with the
¦Â-crystalline form.  Moreover Bhushan claimed that the data was irrelevant
because these institutes were merely reproducing the
mesylate salt by combining methane sulfonic acid with imatinib, which would
obviously result in the mesylate salt.  He asserted that this proved nothing,
and that the true test to show that Novartis' patent application was without
merit would be for Natco to have supplied the institutes with nothing more than
the '93 patent, and asked them to come up with a suitable salt with equivalent
or better bioavailability as the mesylate salt.

He then started to go through the affidavit that had been objected to, when J.
Sridevan interjected and stated that given the tenor of the affidavit, which
implied that IIT and IICT had inadequately performed these tests without taking
proper precautions, she felt that it was unfair for Novartis to rely on such an
affidavit.  She stated that ruling on this would require the Court to question
the integrity of these institutes.  Bhushan conceded this point.

He then relied on another affidavit that had been made available to the Patent
Controller which stated that it was unsurprising that IIT and IICT could come up
with nothing but the ¦Â-crystal form, as Natco had never had access to the
¦Á-crystal form, and that the samples that Natco had supplied to these
institutions would have inevitably been contaminated with ¦Â-crystal seeds, thus
invariably resulting in the creation of the ¦Â-crystalline form.

Bhushan then relied on some orders passed in infringement proceedings
against Natco in the UK, in which Natco had agreed not to market or sell the
¦Â-crystalline form because it would infringe Novartis' '93 patent.

At this point, the Court adjourned for the day.  Bhushan will continue his
arguments tomorrow.

[correction:  yesterday's update incorrectly mentioned Ranbaxy's holding
counsel's name as Ganeshan.  The lawyer representing Ranbaxy was Mr. Anil
Mishra.]

In solidarity,

Lawyers Collective HIV/AIDS Unit

Anand
Chan
Julie
Divya

Julie George
e-mail: <george.julie@...>

Ophthalmic Manifestations of HIV Infection

Author(s): Kalpana Suresh. Vol. 3, No. 4 (2006-08 - 2006-09). Review Article.ISSN No: 0973-516X. Indian Journal of Pactising Doctor

Kalpana Suresh

Dr. Kalpana Suresh, M.S.,F.R.C.S (Glasg) is Associate Professor & Consultant Ophthalmologist, Sri Ramachandra Medical College & RI (DU), Porur, Chennai-600116

Numerous ophthalmic manifestations of HIV infection may involve the anterior or posterior segment of the eye. Anterior segment findings include tumors of the periocular tissues and a variety of external infections. Posterior segment changes include an HIV-associated retinopathy and a number of opportunistic infections of the retina and choroid.

Due to the potentially devastating and rapid course of retinal infections, all persons with HIV disease should undergo routine ophthalmologic evaluations. In patients with early-stage HIV disease (CD4 count >300 cells/ìL), ocular syndromes associated with immunosuppression are uncommon.

Nonetheless, eye infections associated with sexually transmitted diseases (STDs) such as herpes simplex virus, gonorrhea, and chlamydia may be more frequent in HIV-infected persons. Therefore, clinicians should screen for HIV in the presence of these infections.

Anterior Segment Diseases

a) Kaposi Sarcoma: Kaposi sarcoma is a highly vascular tumor that appears as multiple red nodules on the eyelids and conjunctiva. It may appear as a persistent subconjunctival hemorrhage. It does not invade the eye, and no treatment is necessary if it causes no symptoms. Otherwise, it is treated by cryotherapy, surgical excision, radiation, or chemotherapy

b) Infections

Herpes Zoster Ophthalmicus: Herpes zoster ophthalmicus (HZO) is characterized by a vesiculobullous rash over the ophthalmic branch of the trigeminal nerve and may be associated with keratitis, conjunctivitis, blepharitis, and uveitis. Although HZO most commonly affects older individuals, it may be an initial manifestation of HIV infection in a young person.¹

Adults with an acute, moderate-tosevere skin rash may receive acyclovir orally and bacitracin ointment for skin lesions. In the presence of uveitis, topical prednisolone and cycloplegic should be applied. In cases of retinitis, choroiditis, or cranial nerve involvement, intravenous acyclovir is indicated.

Herpes Simplex Keratitis: Herpes simplex virus (HSV) can cause painful and often recurrent corneal ulcerations with a characteristic branching or dendritic pattern on slit lamp examination. HSV keratitis often is associated with corneal scarring and iritis. It requires prolonged course of treatment, and recurs frequently. Treatment consists of topical acyclovir and cycloplegic drugs, with debridement of the ulcer using a cotton-tip applicator. Oral acyclovir (400 mg twice daily for 1 year) decreases the risk of recurrent HSV keratitis by 50%.²

Fungal Infections: Defects in cellular immunity also may play a role in susceptibility to corneal infections. Spontaneous fungal keratitis secondary to Candida has been observed in persons with advanced HIV disease and a history of antecedent trauma.

Syphilis: It causes the following lesions in the posterior segment – chorioretinitis, retinal perivasculitis, intraretinal hemorrhage, papillitis, and panuveitis. Ocular involvement may be unilateral or bilateral and is associated with evidence of central nervous system infection in up to 85% of patients.3 Therefore, lumbar puncture and cerebrospinal fluid analysis is recommended for the evaluation of patients with ocular syphilis who are seropositive for HIV. Syphilis can run a more rapid and aggressive course in HIVinfected patients than in immunocompetent individuals.

Antibiotic regimens recommended for the treatment of syphilis in immunocompetent patients may not be appropriate for patients with concomitant HIV disease. Administration of intravenous penicillin for longer periods resulted in improvement of vision in HIVpositive patients with ocular syphilis.

Uveitis

Uveitis occurs with, and may be the first sign of, several chronic infections seen frequently in patients with HIV disease, including tuberculosis, syphilis, histoplasmosis, coccidioidomycosis, and toxoplasmosis. Unexplained uveitis in an HIV-infected patient should prompt a search for an underlying infection.

Posterior Segment Diseases

Infection with HIV predisposes the retina, choroid, and optic nerve to a variety of disorders that may be divided broadly into two categories: those associated with noninfectious causes and those due to infections.

a) Manifestations Not Associated with Opportunistic Infections

Retina: HIV retinopathy is a noninfectious microvascular disorder characterized by cotton-wool spots, microaneurysms, retinal hemorrhages, telangiectatic vascular changes and areas of capillary nonperfusion. These are the most common retinal manifestation of HIV disease and are clinically apparent in about 70% of persons with advanced HIV disease.

Cotton-wool spots occur in approximately 50-60% of patients with advanced HIV disease and are the earliest and most consistent finding in HIV retinopathy (Figure 1). They represent infarcts of the nerve fiber layer. They are not vision threatening. They can be distinguished by their smaller size, superficial location, lack of progression, and tendency to resolve over weeks to months.

Optic Disk: Noninfectious optic nerve involvement in patients with HIV disease includes papilledema, anterior ischemic optic neuropathy, and optic atrophy. Papilledema usually occurs in patients with advanced HIV disease and CNS malignancies.

B) Manifestations Due to Opportunistic Infections

A number of infections of the retina and choroid have been reported to affect individuals with advanced HIV disease. The more commonly encountered debilitating infections are included in this review.

Cytomegalovirus Retinitis: CMV retinitis is the most common retinal infection in patients with HIV disease, occurring in 15-40% of patients with advanced HIV disease. It is bilateral in 30-50% of patients. It occurs when the CD4 count falls below 50 cells/ìL.

CMV is a DNA virus classified in the herpes group of viruses. CMV invades retinal cells with resultant retinal necrosis. Retinal lesions appear as multiple granular white dots with hemorrhage (Figure 2). They enlarge and coalesce over time and follow the vascular arcades. Frosted branch angiitis may be seen in conjunction with CMV retinitis (Figure 3). After several weeks, retinal lesions atrophy.⁴ The underlying retinal pigment epithelium demonstrates pigment loss and migration, resulting in increased visualization of the underlying choroidal vasculature.

CMV retinitis responds to initial therapy. Recurrence usually begins at the margins of previously active infection and tends to "smolder" rather than actively progress. It will continue to spread, slowly but inexorably, if the treatment regimen is not altered. Patients with recurrent infection, while they are on appropriate levels of maintenance therapy, have an especially poor prognosis for preservation of sight, even with the use of increased doses of medication.

With the introduction of effective Anti-Retroviral Therapy (ART), the incidence of CMV retinitis has been noted to decrease by about 75%. Prior to the availability of effective ART, the median time to progression of treated CMV was 3- 9 months.

Ganciclovir Intraocular Implant

Direct intraocular administration of ganciclovir has the benefit of achieving therapeutic levels by bypassing the bloodretinal barrier. Furthermore, systemic absorption is minimal. Therefore, systemic complications are avoided, but protection of contralateral eye is not achieved. Therefore, oral prophylaxis with ganciclovir often is used in combination with the intraocular device.⁵ The ganciclovir intraocular device (GIOD) consists of a 6-mg pellet of ganciclovir. The resultant sustained linear drug release provides 3 or 6 months (depending on pellet construction) of anti- CMV activity. (Figure 4).

Surgical Management of Retinal Detachment

Retinal detachments secondary to CMV retinitis occur in 17-34% of patients⁶. Surgery should be considered in all patients with bilateral CMV retinitis because the eye with the retinal detachment ultimately may be the betterseeing eye. Vitrectomy with an intraocular silicone oil tamponade is the preferred operation in these patients. Scleral buckling is a different surgical technique in which a silicone sponge or band is affixed to the equator of the globe to support and keep the retina in position. For this procedure to be successful, the detachment should be small. Pneumatic retinopexy is a procedure that involves the injection of a gas bubble into the globe, with subsequent positioning of the patient so that the bubble's natural upward force pushes the retina back into position. Retinal laser or cryopexy may be used to "surround" and tack down the retina around a small peripheral retinal detachment in patients who are unable or unwilling to undergo surgical intervention.

Toxoplasma Retinochoroiditis

Toxoplasma gondii is a protozoan parasite, the life cycle of which includes encysted and active forms. In HIVinfected patients it causes multifocal sites of retinochoroidal infection with less frequent vitritis.⁷ Bilateral eye involvement also may be seen in patients with HIV disease, and proliferative vitreoretinopathy may accompany later stages of the disorder.

Toxoplasma retinochoroiditis may be confused with other forms of retinitis, but it usually can be differentiated by the presence of intense, almost fluffy, areas of retinal whitening with accompanying vitritis (Figure 5). Toxoplasmosis commonly involves the central nervous system in patients with advanced HIV disease and results in neurologic manifestations in 10-40% of affected individuals.

Serologic studies have been relatively unreliable for the diagnosis of toxoplasmosis in HIV-infected patients. However, toxoplasmosis is unlikely in a patient with a negative IgG anti- Toxoplasma antibody.

Patients with vision-threatening lesion may warrant a therapeutic trial using pyrimethamine and either sulfadiazine or clindamycin in standard dosages.⁸ Maintenance therapy with pyrimethamine and either sulfadiazine or clindamycin results in fewer relapses of infection than does pyrimethamine alone, and may need to be continued indefinitely while CD4 counts remain low.

Candida Endophthalmitis

Typical candidal fungal lesions appear as fluffy white "mounds," which are frequently bilateral and superficially located, and often extend into the vitreous. There usually is an overlying vitritis, and vitreous abscesses may be seen. Candida retinitis is not commonly seen in HIVinfected patients, but may be more likely in the setting of intravenous sources of infection (including indwelling catheters).

Bacterial Retinitis

Bacterial chorioretinitis, although infrequently seen, should be considered in patients with advanced HIV disease who present with posterior segment infection unresponsive to treatment for suspected viral, fungal, or protozoan causes.

Cryptococcus Chorioretinitis

Cryptococcus neoformans is a yeast that causes ocular infection in immunosuppressed individuals. CNS involvement with Cryptococcus in HIVinfected patients is relatively common and often results in meningitis with secondary ocular findings. Choroiditis and chorioretinitis from cryptococcal infection also have been observed in HIV-infected patients. Visual loss may occur which has been attributed to cryptococcal involvement of afferent tissues including the optic nerve, chiasm, and tract

Pneumocystis Choroiditis

Pneumocystis carini causes pneumonia (PCP), the most common systemic infection in patients with HIV disease in developed countries. Multiple pale yellow-white choroidal lesions, usually in both eyes, clinically characterize Pneumocystis choroiditis.⁹ The lesions generally are round or ovoid and of variable size, and may coalesce to form large confluent regions resulting in choroidal necrosis. If this process involves the foveal area, loss of central vision may occur. Of note is the almost total lack of an associated inflammatory response in the retina, vitreous, and anterior segment.

Acute Retinal Necrosis

Acute retinal necrosis (ARN) is a rapidly progressive viral uveitis. Peripheral retinal whitening, that progresses to necrosis over several days, characterizes ARN. Bilateral involvement may occur, and retinal detachments with proliferative vitreoretinopathy commonly occur10. Several viral pathogens have been associated with ARN. Varicella-zoster has been the most frequently implicated virus. HSV and CMV also have been associated with this disorder. Whereas ARN responds to treatment with intravenous acyclovir in immunocompetent individuals, it is much more recalcitrant to treatment in HIVinfected patients. The currently recommended treatment involves standard induction dosages of ganciclovir or foscarnet, with adjunctive high-dose intravenous acyclovir.

References

1. Cole EL et al. Herpes zoster ophthalmicus and acquired immune deficiency syndrome. Arch Ophthalmol 1984; 102:1027-9.
2. Herpetic Eye Disease Study Group. Acyclovir for the prevention of recurrent herpes simplex virus eye disease. N Engl J Med 1998; 339:300-6.
3. Levy JH, Liss RA, Maguire AM. Neurosyphilis and ocular syphilis in patients with concurrent human immunodeficiency virus infection. Retina 1989; 9:175-80.
4. Fay MT, Freeman WR et al. Atypical retinitis in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol 1988; 105:483-90.
5. Martin DF et al. Oral ganciclovir for patients with CMV retinitis treated with ganciclovir implant. Ganciclovir Study Group. N Engl J Med 1999; 340:1063-70.
6. Broughton WL, Cupples HP, Parver LM. Bilateral retinal detachment following cytomegalovirus retinitis. Arch Ophthalmol 1978; 96:618-9.
7. Quinlan P, Jabs JA. Ocular toxoplasmosis. Retina 1989;89:563
8. Schmitz K, Fabricius EM, Brommer H. [Prevalence, morphology and therapy of toxoplasmosis chorioretinitis in AIDS]. Fortschr Ophthalmol 1991; 88:698-704.
9. Urayama A, Yamada N, Sasaki T, et al. Unilateral acute uveitis with retinal periarteritis and detachment. Jpn J Clin Ophthalmol 1971;25:607.
10. Freeman WR et al. Demonstration of herpes group virus in acute retinal necrosis syndrome. Am J Ophthalmol 1986; 102:701-9.

Figures and Legends

Fig 1. Cotton wool spots are the most common non-infectious retinal manifestation of AIDS.

Fig 2. CMV infection of the retina produces widespread retinal necrosis and hemorrhage.

Fig 3. Frosted branch angiitis may be associated with CMV infection

Fig 4. The ganciclovir implant as seen through a dilated pupil (it is not visible in the undilated state).

Fig 5. Toxoplasmic retinochoroiditis often presents as a zone of retinal whitening and thickening with vitritis and less retinal hemorrhage than is usually seen with cytomegalovirus retinitis

http://www.indmedica.com/journals.php?journalid=3&issueid=84&articleid=1145&action=article

On-Site Project Manager, ART adherence study (Prerana Project)

St. John's Medical College and Hospital, Bangalore, India
In collaboration with the University of California, San Francisco
(UCSF)

Job Description
Manage day-to-day operations of an international collaborative
research project examining behavioral, clinical and laboratory
aspects of adherence to anti-retroviral therapy (ART) among HIV
infected patients at St. John's Medical College and Hospital,
Bangalore including:

Communication
Maintain ongoing communication with the San Francisco based team on a
daily basis (via email) and a weekly basis (via phone). Some late
evening calls may be necessary.  Responsible for communication with
on-site and off-site laboratories to ensure timely, quality
controlled lab results. Communicate with study investigators study
statistician, local NGOs, and appropriate government bodies as
necessary under the supervision of the Principal Investigators (PIs).

Research management: Implement ongoing project protocols and quality
control protocol in coordination with key project investigators. The
study currently has one project office, but will expand to two sites
in the fall of 2007.

Staff Supervision
Recruit and train, data entry, data management, outreach workers and
study interviewer and counseling staff in coordination with on-site
and San Francisco-based key investigators. Supervise study
interviewers, assistant project manager, outreach workers/counselors
and data staff. Supervise all aspects of data collection, including
recruitment, enrollment, and follow-up of study participants to
ensure adherence to study protocol. Determine appropriate staff
development training opportunities in consultation with the PIs and
San Francisco based team. Coordinate regular staff meetings and
maintain meeting agendas.

Office Management/Administration
Draft regular progress reports in consultation with on-site PIs for
grant management and operational reporting to the San Francisco based
team. Oversee a budget of approximately US $150,000 a year, including
budget development, maintenance of financial records, and periodic
reporting. Coordinate with the Business Manager to maintain
subcontracts and accounting per protocols established by UCSF and St
John's Hospital. Manage an office on the grounds of St. John's
Hospital, including ordering of all study-related supplies. Develop
protocols that conform to St. John's standards in coordination with
on-site investigators for lab data analysis at in-house and external
laboratories.

Required skills and experiences:
1. Three or more years of project management experience,
including overseeing budgets, staff management, and financial
reporting, preferably in a health research setting
2. Excellent written, verbal, organizational, and interpersonal
skills
3. Ability to work with diverse populations, castes, and social
backgrounds. Ability to maintain strict confidentiality and the
ability to cope with challenging situations
4. Flexibility, patience, attention to detail and ability to
work independently
5. Proficiency in English and knowledge of two or more Indian
languages. One of these needs to be a South Indian language,
preferably Kannada.
6. PG in relevant field such as public health, social work,
psychology, business/management, or related field
7. Experience with Microsoft Office software (Word, Excel,
PowerPoint, & Access).

Preferred skills and experiences:
1. Preference will be given to candidates with experience
managing international or NIH-funded research and working in health
care settings.
2. Experience with quantitative data collection and management.
3. Knowledge of HIV/AIDS-related medical and
behavioral/psychosocial issues in an Indian context
4. Experience with data management software.

Exact salary will depend on experience, but is budgeted to be in the
range of Rs. 20,000-30,000 per month. Projected start date will be
May 2, 2007.

We encourage applications from all qualified candidates regardless of
gender, caste, religion, sexual orientation, or HIV status.

Please send your CV and cover letter to:

preranaproject@...

Last Date: 10th April 2007


"reachlance1004"
e-mail: <reachlance1004@...>

Dear FORUM,

Re: The dilemma of circumcision for Hindus. Absolutely... The dilemma will be
profound in the minds of all the parents to think abt this eventuality as the
guiding prinicple for circumcising their newly born sons and i amnot even
talking abt the religious dilemma which to me is irrelevent if it ever was!.

For me it is yet another case of transplanting the ethos and findings of foreign
study into indian shores with out looking in to the social implications of it.

I still believe that the authors of such reports would not be wanting the public
health officials in the developing world to lap it up with giving a thought into
the practical difficulties.

Dr Sreejit  E  M
67,Pearson road
Ipswich,IP3 8 NL
UK
Ph:+44-1473-437837
mob:+44-7722015047
e-mail: <emsree@...>

Dear Forum,

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/7073

This is in continuation with the case which was sent to e-forum on 24th March.
This PLHIV was detected as HIV reactive last year.  Her
husband died in January 2007 and she lives with her two years old son.  Her
in-laws stay a few houses away. Since the death of her husband some boys in the
locality have began misbehaving with her (passing remarks etc).  She was running
a small grocery shop in the locality and earning Rs. 25/- per day.

The community knows the status of the women because it was published in the
local news paper (Sambad) in the first week of January, which contained her
photograph and real name.

The community feels that the boys of the area may get involved with her. Hence,
they are trying very hard to evict her by claiming that her character is not
good.

On 24th march, 2007, the community decided to hold a panchayat meeting to evict
her from the village.

Developments: The panchayat meeting didnot happened on 24th march, 2007 and  the
following day, the villager asked her to call for the meeting to prove her
innocence. But she refused saying that she didnot want any problems.

Now the villagers are threatning the mother-in-law to call the meeting. 
Otherwise, she will not get any assistance from the villagers.  At present her
grocery shop is not running at all and she earns nothing.  Over and above due to
the mental stress she is unable to eat well. Now, she needs some support. And
she lives a life of uncertainity not knowing what will happen tomorrow.

Regards

Santosh Kumar
e-mail: <kumarpositive@...>

Contact details of Orissa SACS

Sri Mayadhar Panigrahi, IAS
Orissa State AIDS Control Society,
Oil Orissa Building , Nayapalli,
Bhubaneshwar, Orissa
Tel; Office 0674- 2405134,  0674- 2405104-06
Tel; Residence:  0674-   2401645
Fax: 0674-  2407560, 0674- 2405105
E-mail: sacs_orissa@...

Dear FORUM,

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/7073

Orissa SACS,PSU and the NGO partners may please organize immediate joint meeting
with the village Sarpanch and community leaders (UNDP-Orissa a major partner in
AIDS control activities may facilitate the
visit and interactions)to impress upon them that there is no danger whatsoever
in all types of social interactions with the lady who needs psycho-social
support and not ostracization at this juncture of her
life.

All the people going together to the village will have a positive and effective
impact on the way some of the people in the village are thinking.

The mere presence of government functionaries,senior officials and NGOs with
good credibility and rapport with the local community may do wonders in
obviating such an unwarranted and discriminatory geasture which is wrong from
all points of views.

Please do take it up on a priority.

Best wishes,
Dr.Rajesh Gopal.
E-MAIL: <dr_rajeshg@...>

Novartis update for 27 March 2007

The Novartis matter resumed today. Basha continued with his argument that 3(d)
did not provide any guidelines and was therefore arbitrary. He cited judgments
to show that where Parliament does not provide guidelines the act can be voided
as arbitrary under Art. 14 of the Constitution.

He argued that the decision as to whether there was a significant enhancement in
efficacy was left entirely up to the patent controller, and that if the Patent
Controller decided in a particular case, it would adversely affect the consumer
groups who would not have all the necessary knowledge to challenge the order. He
insisted that there should be guidelines either specified by law or by a
notification issued by the government or by subordinate legislation.

At this point, J. Balasubramaniam asked how it would be possible for the
legislature to determine what enhanced efficacy would be in all situations.
Therefore, the law gave the discretion to the patent controller, and if the
patent controller made an error, this could be corrected by the appellate
courts.

J. Sridevan added that fixing a certain standard for all drugs would result in
inequality, as different standard would apply to different drugs.

Basha then again argued that the flexibilities in the Doha Declaration pertained
only to compulsory licensing, and did not contemplate or allow 3(d).

VT Gopalan, the Additional Solicitor General appearing for the Government of
India and the Patent Controller, introduced caselaw to support his argument that
the Court was the final arbiter to determine Parliament's intent. He argued that
the Court could take into consideration all relevant circumstances in
determining the objectives of the legislation.

He then requested that the Court take note of the international community to
section 3d. In this vein, he read aloud certain portions of Congressman Waxman's
letter to Novartis discussing the importance of sec. 3(d) in making drugs
accessible and affordable, and of the "chilling effect" of Novartis's challenge
in encouraging other member states from introducing public health safeguards
into their laws. He also introduced the letter from the Members of the European
Parliament to support these arguments. He then concluded
that this view of the international community reiterated the fact that
patentability standards were meant to be member specific, and that 3(d) was in
compliance with TRIPS.

He then addressed the issue of Novartis' claim that 3(d) conferred excessive
delegation of powers. He argued that the trend in recent times was not to
invalidate the delegation of the discretionary power itself, but to challenge
the improper exercise of that discretionary power in individual cases. He added
that because the function of the Patent Controller was quasi-judicial, in which
all parties were given an opportunity to be heard and avenues for appeal
existed, these provided sufficient safeguards against the exercise of an abuse
of these discretionary powers.

He cited further judgments to support the claim that not all grants of
discretionary power is not discriminatory, and that there is no presumption that
even where wide powers are granted it will be abused.

He then cited further caselaw supporting the primacy of domestic legislation
over international treaty obligations.

At this point, J. Sridevan interjected and said that the primacy of domestic law
was no longer in doubt. She asked, given that Novartis claims that section 3(d)
is not TRIPS compliant, and that the respondents claim that 3(d) is TRIPS
compliant, could the Court express its views on this matter?

Gopalan replied that the Court should not look into the issue at all, and in his
view, the matter was not justiciable.

J. Balasubramaniam asked at this point what his response was to Novartis'
contention that efficacy could not be made a patentability standard because 
efficacy was determined during clinical trials. Gopalan replied that he would
address this issue during the appeals phase.

Then, Lakshmikumaran, apprearing for Ranbaxy and Hetero, began his argument by
claiming that paragraph 5 of the Doha Declaration was not exhaustive of the
flexibilities discussed in paragraph 4. He noted the language in paragraph 4
discussing the right of members to protect public health, as well as the
language in paragraph 5 that discussed flexibilities as including, but not
limited to, compulsory licensing. He argued that this
language gave member states extra elbow room in taking measures to protect
public health, in whatever form.

Lakshmikumaran then responded to Bhushan's argument yesterday about the fact
that if patents did not exist, then there would be no research, no medicines,
and thus people would die. He pointed out that there in fact was no product
patent protection in India until 2005, and yet new drugs were being developed.
Bhushan then clarified that his hypothetical concerned a situation in which no
product protection existed anywhere.

Lakshmikumaran then pointed out that 3(d) was a valid exercise of the
flexibilities available under TRIPS. In response to Bhushan's arguments that Art
27 of TRIPS provided an exhaustive list of exclusions, he read out section 3(a)
which disallows the patenting of frivolous applications, and the latter part of
section 3(d), which excludes new use, neither of which are expressly provided
for in Art. 27. He then argued that section 3(d) only clarified when a patent
application became frivolous in line with the basic
patentability criteria. He explained that section 3(d) was necessary to stop
ever greening, and explained how companies could subsequently patent frivolous
modifications to extend patent protection.

He argued that this was a case in which Novartis claimed not to understand the
concepts of efficacy and significant enhancement of efficacy, and therefore
wanted the law struck down. However, he claimed that Novartis was refusing to
understand the meaning of efficacy, but that in Europe, Novartis fully
understood these concepts and used them to gain marketing approval for many
drugs.

He then argued that the language from the European Directive was actually
borrowed from pre-existing judge-made law in Europe that had become codifed. He
showed how Novartis was actually party to the case in which these concepts were
litigated to show that Novartis had full understanding of what efficacy meant.
The case in which Novartis was involved concerned a "critical dose drug," in
which a slight overdose could prove fatal and a slight underdose could prove
ineffective. He used this example to show how the concepts of "efficacy" and
"significance" could vary from drug to drug, and how Novartis itself was aware
of this fact.

He reiterated that the appropriate forum for determining TRIPS compliance was
before the DSU, and that any such pronouncement by the Court would only result
in embarrassment.

Responding to J. Balasubramaniam's earlier question to Gopalan about whether it
made sense to require a showing of efficacy at the patentability stage,
Lakshmikumaran argued that this was routinely done by patent applicants. He
explained that the industrial application requirement imposed a duty upon
applicants to show that any given molecule it wanted to patent could at least
potentially have some therapeutic efficacy. He claimed that clinical trials
would only confirm the substance's efficacy, and would prove the
safety of the drug. He pointed out that 3(d) excluded the word "safety" that was
included in the EC directive for precisely this reason. He argued that guidance
in legislation is required only when the terms are not known, but that the terms
used in 3(d) were well known to those skilled in the art.

Grover, appearing on behalf of the Cancer Patients Aid Association, began his
argument by asserting that Novartis, not being a party to the TRIPS agreement,
lacked standing and that the Court lacked jurisdiction to issue a declaration of
TRIPS compliance. He brought to the Court's attention cases he had cited earlier
to support the argument that in dualist nations, domestic courts had no role to
play if a country failed to abide by its international obligations, unless the
treaty expressly provided for private rights of enforcement.

He then reiterated his argument that Art. 27 was not exhaustive and pointed to
various provisions in section 3 of the act that were not expressly provided for
in 27.

He then pointed to authorities to show that TRIPS flexibilities extended to
setting stricter standards for patentability by defining the basic criteria of
patentability as it saw fit. He pointed to the CIPIH report, which approvingly
cited section 3(d) of the Act as a valid exercise of TRIPS
flexibilities to prevent evergreening. He then introduced Novartis' own slide
presentation on salt selection, in which Novartis acknowledged the usefulness of
subsequent patents on salts and polymorphs to extend patent protection.

He then distinguished the caselaw that Novartis had cited regarding excessive
delegation, and pointed out that none of these cases applied to the case at
hand, because none of the cases dealt with the validity of the grant of
quasi-judicial discretionary power. He argued that the inherent safeguards in
the grant of quasi-judicial power – i.e., fair hearing, reasoned decision, and
opportunity to appeal was sufficient to check the abuse of such powers.

He then argued that the explanation to section 3(d) actually provided the
further guidance to the patent controller in two ways: to show what new forms of
known substances are, and to explain that "significant enhancement of efficacy"
could be shown by a showing of a "significant difference in properties with
regard to efficacy."

Bharat Raman, appearing for Natco, argued that Novartis, throughout the
prosecution of the application, had full knowledge of what was meant by efficacy
and enhancement of efficacy. He cited to Novartis' own replies to the patent
oppositions in which Novartis had argued that the beta-crystal form was a
significant enhancement over the free base. Raman argued that it was only
because Novartis had failed before the patent controller that they were now
claiming that they were ignorant of the meaning of these concepts.

He cited to further caselaw to show that it was precisely the duty of the Court
to give meaning to terms in legislation. In this vein, he compared section 3(d)
to a new born baby, and implored the Court to give it time to grow.

He further argued that there was nothing inappropriate in borrowing concepts
contained in one legislation for use in another body of law. He cited to the old
Patents Act, 1970, which borrowed the concept of "drug" from the Drugs and
Cosmetics Act.

Responding to Novartis' argument that its novelty could be possibly lost if it
were required to disclose test data to obtain a patent, Raman referred the
judges to section 30 of the Act. This provision protects communications made by
an applicant to the government in furtherance of an investigation of the
invention.

The matter was adjourned until tomorrow.

In solidarity,

Anand
Chan
Julie
Prafulla

Julie George
e-mail: <george.julie@...>

[Moderators note: In my conversation with Mr. Santosh Kumar, he
indicated the seriousness of the matter and his request appears to be
genuine and urgent]

Dear forum,

It has come to the notice of the local PLHA group that a Women PLHIV
of Jeypore Block , Koraput dist (Bariniput Panchayat,  under Jeypore
police station) has been constantly harassing by the local community.

It seems, now they are planning to hold a panchayat meeting, to
chase  this lady from the village.

The village elders indicated to this lady that she should be gone
from the village otherwise they would forcefully evict her from the
village.

Has the village sarpanch and the panchayat any right to evict her
from the village?

Kindly advice us on what should be done in order to avoid her
eviction from the village.

We request Orissa SACS or some other agencies to help us

Please treat this as very urgent

My Mobile Number is 09437871499.

Warm Regards

Santosh Kumar
e-mail: <kumarpositive@...>

Invitation:  Migration &  Mobility:  Impact On Acquiring HIV in Film
Industry

Invitation to explore ……… from Society for Development Research and
Training (SFDRT), Pondicherry & Chennai: We cordially invite you with
your colleagues and friends on a bouquet of dissemination of research
findings on the  "Patterns of Migration with Mobility and Its Impact
On Acquiring HIV/AIDS Among the Employees Working in the Ve rnacular
Film Industry of South India" – Research Initiative

Venue: UN Conference Hall – Delhi 55
Day & Date: March 29, 2007 (Thursday)
Time: 4.30pm – 6.30pm
Speakers: Ms. Shyamala Ashok (SfDRT) – Principal Investigator, Dr. K.
Jayaraman – Consultant (Statistics & Analyst) – Mr. Innacy Rocky – Co
Investigator (SfDRT)

SFDRT, a twelve year organization implementing differed
interventions, aiming at behavior change, mooted towards prevention
of HIV/AIDS and its care continuum. While hypothesizing a very high-
risk sexual behavior, with a large intensity among those working
within the film industry, (supported by CAPACS/NACO) we probably
reconfirmed a prevalence rate of HIV among 3% of the population. The
need to work was established, with the high-risk behavior being
prevalent among 90% of the target groups, covered by us so far (4000
members). Mobility & migration were major factors for increased
sexual behavior. Research findings aimed and understood the migratory
patterns, coupled with the ideas of sex and sexuality that prevailed
within the minds of the target group, and answered whether migration
and the mind set had a synchronization for the high risk behavior,
exercising the learnt and expected behavior, obstacles found towards
the expected behavior and most of all told us where exactly we could
touch on the expected behavior change that could be worked with
higher intensity.

Overall goal aimed to study the patterns of migration, with the
extent of mobility, its impact & interception towards acquiring
HIV/AIDS, among the employees working in the vernacular film industry
of South India. It is understood that multi partner sexual activities
and sex work is a part of the required glamour to work within the
film industry, which enhances the vast possibilities to become
infected with HIV/AIDS and migration would further contribute to
enhance the relationships not only within the film industry, but also
with others around their place of migration. In the process there are
considerable chances of increased numbers of new HIV infections. It
is further understood that the first sexual contact among these
groups are below 19 years and this could further enhance the risk,
with a logical hypothesis that adopting safe sex measures at this age
could be difficult due to several reasons.

Target groups with the geographical areas: The prime groups were of
high risk sexual behaviors, comprising of clients to sex work,
females working in the film industry catering to multi partner sexual
activities and some adapting to sex work on part time. The HIV
infections cut across this group largely due to migration which is
through selective places of India, while they work not only for the
Tamil industry but also cater their services to Andhrapradesh,
Karnataka, kerala and some of them work for the Hindi films in
Maharashtra. All places of work they chose to are identified states
of high risk to HIV prevalence. The work place operations require
them to encompass themselves to short term and long-term migration.

The study catered to gender and its perception as a cross cutting
feature within mobility& migration. The understanding of the above
was mooted into research thoughts & actions. Integrated research
findings will be integrated and used for the development of policies,
so as to lay a platform for a change in behavior, which will then
provide stepwise acceptance by the target group it self. Case studies
were used to prove the findings and ensured that small round table
discussions followed by seminars, enhanced acceptability. Acceptance
of the research findings along with the elucidated impact studies on
gender, power and migration; itself will pave the way for its
sustenance.

This study was conducted within the FEFSI (Film Employees Federation
of South India) comprising of 22 unions with a sample size of 2000.
(10%) of the population.

Ms. Shyamala Ashok
Executive Director, SFDRT
Rathna Complex, Anna Salai, Pondicherry - 605001
Tel: 91-413-2225658; 22220058
email: sfdrt@..., aabinand@...
web:   www.sfdrt.org

Important information on MDR TB!!

I see that experts have suggested development of advanced diagnostic facilities
and drug availability for dealing with MDR TB.

But we also need to look at why there are more cases of MDR. It is because
people are leaving the treatment halfway after visible signs have diassappeared.
This is the greatest challenge and i would like to suggest that the quality of
counselling and follow-up mecahnisms have to improve as well as the problems
related to the access for working people have to be addressed.

Only then we can we can make some headway. This will also help in achieving the
target of detection rate.

Only developing better diagnostic techniques may not help.

Swati Pongurlekar
e-mail: <swatip187@...>

Dear Moderator

Our Institute is carrying out a study on Status of Child Rights in respect of
HIV / AIDS threat to children.

Those who have worked on this topic may kindly share their xperience &
literature or data in their possesion.

We will be thankful.

Dr S K Trivedi
IIDM Bhopal
e-mail: <iidmbpl@...>

HIV/AIDS Universal Access to Treatment Memorandum
New Delhi, India 2007

Respectively submitted to: The Honorable President of India Dr.
A.P.J. Abdul Kalam On the day 24th, March 2007

In recognition of the positive initiatives that you have created to
support and assist people living with HIV/AIDS in India, we call on
you to consider the following issues that require your leadership:

1. Whereas it is unknown how many people in India are currently HIV
positive and in need of anti-retroviral (ARV) treatment, we call for
expanded free and accessible HIV testing services that will reach all
of the affected communities, including rural.

2. Whereas HIV/AIDS is a preventable disease, we call for revitalized
prevention campaigns that will reach communities at risk and will help
stop the transmission of this deadly virus.

3. Whereas women and children are at the most risk for HIV/AIDS, we
call for an increase in access to ARV treatment centers - especially
in the rural areas -- as well as women-specific and pediatric
treatment guidelines to be developed by the government.

4. Whereas first line ARV treatments are failing and clients are
increasing facing resistance nationally, we call for the government to
approve the provision and availability of life-saving second- line
therapies.

5. Whereas ARV treatment regimens must be clearly understood in order
to be effective and to avoid resistance, we call for treatment
literacy programs that will reach the people, both in rural and urban
communities.

6. Whereas National AIDS Control Organization (NACO) is responsible
for the provision of appropriate HIV/AIDS prevention, treatment, care
and support services, we call on NACO for accountability and
responsibility in  providing HIV/AIDS treatment to all in need in
India by 2011.

For all of critical issues, we ask for your leadership and support.

Respectfully submitted by:

AHF/IndiaCares
ActionAID
Positive Women Network (PWN+)
Delhi Network of Positive People (DNP+)
India Network of Positive People (INP+)
DISHA
Human Rights Law Network (HRLN)
Swami Vivekananda Youth Movement (SVYM)
Angikar Bangladesh Health Rights and Care Group
Bharti Derma Care and Research Center
UNESCO, and other civil society groups and communities

SOURCE Aids Healthcare Foundation

Volume 356:1197-1201		March 22, 2007		Number 12

On April 1, 2007, India will launch a new phase of its National AIDS Control Program (NACP). Its goals include reducing the number of new human immunodeficiency virus (HIV) infections — currently, an estimated 98.5 to 99.5% of India's 1.1 billion people remain uninfected — improving treatment, and providing therapy to more people. The 5-year program, known as NACP-III, has a budget of about $2.6 billion, two thirds of which is earmarked for prevention and one sixth for treatment (with the remainder primarily for management), and represents a substantial increase in the attention to and spending on HIV–AIDS. More than 80% of the funds will come from outside India — from the World Bank and other international organizations, governments, and philanthropies. Most of the funding has already been committed.

When I visited India earlier this year, it was evident that the HIV epidemic was only one of the country's many pressing health problems.¹ India must decide whether to commit more of the resources that are fueling its rapid economic growth — and the growth of its private health care industry — to improvements in public health and basic health care.² In 2003, public expenditure on health represented only 1.2% of India's gross domestic product.³ There are 60 physicians per 100,000 population (as compared with 230 in Britain and 256 in the United States). With regard to HIV, challenges include increasing the number of patients receiving treatment, making additional antiretroviral medications available, improving the monitoring of therapy, training physicians and other health care workers, caring for patients with tuberculosis coinfection (see pages 1198–1199), and reducing stigma and discrimination.

Although prevention will account for a smaller percentage of the total NACP resources than at present, it will remain the focus of India's AIDS control strategy. The components of the strategy are similar to those in other South Asian countries and include intensive prevention efforts directed at the high-risk groups of commercial sex workers, injection-drug users, and men who have sex with men, as well as "bridge populations" such as truckers and migrant workers.⁴ Avahan (Sanskrit for "a call to action"), the India AIDS initiative of the Bill and Melinda Gates Foundation, addresses gaps in India's national response and aims "to prove that prevention can be done at scale," according to Ashok Alexander, the program's director. The components of India's strategy also include expanded HIV counseling and testing and treatment for sexually transmitted diseases, broad communication of information on prevention, promotion of condom use, an increase in the proportion of blood donation that is voluntary (since payment for donation attracts high-risk donors), improved access to safe blood, and expansion of programs for preventing mother-to-child transmission.

Each year, about 28 million children are born in India. Skilled health care personnel attend less than half of all births; infant mortality is about 55 per 1000 live births. In 2004, only an estimated 4% of all pregnant women received HIV counseling and testing, and only about 2% of HIV-positive pregnant women received antiretroviral prophylaxis, usually consisting of a single peripartum dose of nevirapine. Moreover, HIV-positive pregnant women may benefit from antepartum combination antiretroviral treatment for their own health. Under NACP-III, more pregnant women should receive monitoring of their CD4 cell counts, antiretroviral treatment, regimens designed to prevent HIV transmission (including combinations of antiretroviral drugs), and other services.

In scaling up treatment, India's domestic pharmaceutical industry has a critical role. A paradox is that Indian companies have become major suppliers of low-cost generic antiretroviral medications to low- and middle-income countries in Africa and elsewhere at a time when there are still major unmet needs for HIV treatment in India. Cipla, a company based in Mumbai, manufactures the largest range of HIV drugs and has the largest market share. Cipla exports 18 times as much antiretroviral medication as it sells domestically, according to Amar Lulla, its joint managing director. Retail drug prices are higher in India than in Africa, in part because of taxes. Eventually, enhanced patent protection for pharmaceuticals in India, which took effect in January 2005, may lead to higher prices. So far, however, no relevant patents have been issued.

Initially, "government activities were not [proceeding] at the speed at which the virus was spreading," according to Suniti Solomon, director of Y.R.G. CARE, a nongovernmental treatment, research, and education facility in Chennai. In April 2004, India launched its public-sector antiretroviral treatment program at eight centers. As of January 31, 2007, about 56,500 patients were receiving treatment at 103 centers (see graph); about 62% were men, 32% women, and 6% children. Perhaps 10,000 to 20,000 additional patients were receiving treatment in the private and nongovernmental sectors. The goal is to have 250 public centers open within 5 years, providing free antiretroviral treatment to 300,000 adults and 40,000 children. However, there is no way to know whether this response will be sufficient.

View larger version (12K): [in this window] [in a new window]   HIV Treatment in Centers Supported by the National AIDS Control Organization, India, April 2004 through January 2007. Data are from Dr. B.B. Rewari, National AIDS Control Organization, Ministry of Health and Family Welfare, Government of India.

The national program provides laboratory tests, such as CD4 cell counts, and medications at no charge to the patient. At present, five first-line antiretroviral medications are provided: the nucleoside analogues lamivudine, stavudine, and zidovudine and the nonnucleoside reverse-transcriptase inhibitors efavirenz and nevirapine. More expensive first-line medications (i.e., tenofovir and emtricitabine) are not provided, nor are second-line medications and more expensive laboratory tests, such as measurement of plasma HIV RNA levels. The immediate priorities are to start patients on first-line regimens, to achieve high rates of compliance through supervised therapy and intensive counseling, to build infrastructure, and to ensure that people are not "dying for lack of access to drugs that are available and affordable," according to Sujatha Rao, the director general of India's National AIDS Control Organization.

It seems inevitable that the national program will have to cover additional first-line treatments, second-line treatments, and measurement of plasma HIV RNA levels and that its protocols will eventually reflect the updated recommendations of the World Health Organization.⁵ Yet the costs of such tests and second-line medications — which, at about $2,000 a year, are about 10 times those of some first-line regimens — remain formidable. According to Rao, a policy of covering additional drugs is "a big responsibility. Once the government says it will provide you with these drugs, it is a commitment forever."

The largest AIDS care center in India is the Government Hospital of Thoracic Medicine, Tambaram Sanatorium, Chennai. Established in 1928 as a 12-bed private tuberculosis sanatorium, it now has extensive outpatient and laboratory facilities as well as 32 inpatient wards, with a total of 776 beds; 8 of the wards are devoted to patients with HIV. Between April 2004 and February 2007, more than 5000 patients began antiretroviral therapy at the hospital. "Every other government and private hospital would just throw the patient out as soon as they found they were HIV-positive," says Soumya Swaminathan, deputy director of the Tuberculosis Research Center in Chennai. "At Tambaram, anyone could walk in at any time. They would be taken care of."

In India, as in much of the world, stigma and discrimination present major barriers to controlling AIDS. In 2005, the HIV–AIDS unit of the Mumbai-based Lawyers Collective, which provides free legal aid, drafted comprehensive antidiscrimination legislation. India's parliament has yet to consider the bill. There are other antidiscrimination efforts, such as a campaign to persuade the courts to overturn, or the parliament to rewrite, Section 377 of the Indian Penal Code, which makes homosexuality illegal and punishable by imprisonment.¹

Within the next several months, a more accurate estimate of the number of HIV-infected people in India should be released. Although the estimate is eagerly awaited, its effect, if any, on India's resolve is a matter of conjecture. Regardless of the number, the new phase of the AIDS control program is just beginning, and the challenges remain immense.

Source Information

Dr. Steinbrook (rsteinbrook@... ) is a national correspondent for the Journal.

References

1. Steinbrook R. HIV in India -- a complex epidemic. N Engl J Med 2007;356:1089-1093. [Free Full Text]
2. Luce E. In spite of the gods: the strange rise of modern India. New York: Doubleday, 2007.
3. The 2006 human development report. New York: United Nations Development Programme, 2006. (Accessed February 26, 2007, at http://hdr.undp.org/hdr2006/report.cfm.)
4. Moses S, Blanchard JF, Kang H, et al. AIDS in South Asia: understanding and responding to a heterogenous epidemic. Washington, DC: World Bank, 2006.
5. World Health Organization. Antiretroviral therapy for HIV infection in adults and adolescents: towards universal access: recommendations for a public health approach. 2006 Revision. (Accessed February 26, 2007, at http://www.who.int/hiv/pub/guidelines/en/.)

http://content.nejm.org/cgi/content/full/356/12/1197

Abstract: A study on the utilization of a peer to peer, HIV/AIDS related
electronic discussion forum: Result of the survey of AIDS INDIA e FORUM:

Joe Thomas. Editor/Moderator, AIDS INDIA e FORUM
http://health.groups.yahoo.com/group/AIDS-INDIA/

Peer to peer electronic FORUMS have evolved as an effective tool for
information and communication.  This study report the findings of the
effectiveness of a peer to peer, HIV/AIDS related electronic
discussion group. AIDS INDIA e FORUM is one of the largest e FORUM
with more than 4,600 subscribes who received 5-6 HIV/AIDS messages,
information and communication on a daily basis for the last six
years. This project is run on a Zero Budget. Accredited for Health on Net Code
(HON Code) of trustworthy health information.

Method. A brief questionnaire was send to all the subscribers during
December 2006. The time frame to respond to the questions were one
month an a reminder was send after 15 days.

Results. 118 valid responses were received. 24% of the respondents
were counsellors and social workers 8% were civil servants. 84% of
the respondents were from India.  35% of the respondents were women
and 64 % men. 37% of the respondents were 30-39 age category and 34%
were belongs to 40-49 age bracket.

1) Rating of the FORUM

42% of the respondents rated the forum as excellent- as  the overall
value of AIDS INDIA e FORUM as a regular source of AIDS related
information. 49% reported it as a `GOOD' source of information.

2) % of the messages read by the respondents

42% of the respondents read all or almost all (75-100%) of the
messages weekly and 42 percent read many (50-75%)

3) The frequency of subscribers participation

The frequency of the subscribers direct participation in the
discussion by way of posting message varied. 6%  participated weekly,
4% fortnightly, 14% once a month, 14% once in three months, 16% once
in six months. 45% never posted any messages on the FORU,

4) Reasons for not participating

The reasons for not participating in discussions on the forums was
due to too much information for 7%, prohibitive cost and expenses of
the internet for 3%, 3% of the agencies  where the respondents work,
prohibits posting messages on the e FORUMS. 5% do not have regular
access to internet connection.  31% have no time/too busy. 49% of the
respondents are just happy to read the discussions. None reported not
confident in English as the reason for not participating in the
discussion.  4% did not  know how to submit messages on the FORUM.
11% were reluctant to give opinions in public

5) Nature of most useful messages

The response to the question, what type of messages do you find most
useful was of multiple choice. 66% of the respondents reported
discussion of specific topics by other subscribers was most useful.
61% reported announcements of conferences, scholarships,  web sites
and job vacancies were most useful. 61%  of the respondents reported
journal articles, book references were useful. 42% for conference
coverage, 65% project reports, lessons learned, best practices, 39%
links to resources on the Internet, 28% cross postings from other
lists, and 24% of the respondents reported requests for information
was most useful.                ]

6) What do the subscribers do with the messages?

81% of the respondents used the information from the FORUM to
increase current knowledge and awareness about HIV/AIDS.  46% used
for program development/ Policy development. 14% used in clinical
management,  43% for teaching and  research. 59% shareed information
with colleagues, 31% used for networking. 20% print messages and keep
these in the resource centre. Following are some of the examples of
how the AIDS INDIA e FORUM has been helpful to respondents in their
work


1. "Keeps me updated on the latest developments and I have used
the same in my trainings

2. helps me to learn the latest development or current news in
this ever changing field of HIV"

3. "It is useful to answer the questions of students when I
conduct sessions for adolescence"

4. "Through the information I have received from the FORUM,  I
attended and presented A paper on HIV In Canada"

5 "It helps me  to make me confident that I can express  my own
views on HIV/AIDS in India"

6. "Keeping me abreast on the HIV/AIDS related updates".

7. "Details of conference, or studies conducted elsewhere have
helped me programmatically"

8. Helped us in recruitment of candidates for various vacancies
and helped us to advertise our own training programs

9. The Forum increases our knowledge on the topic. It brings
latest updates about HIV/AIDS in India and globally

10. Manny  important issues have discussed in this
forum

11. With out this service, it was  not possible to understand what
programmes
are going on  in different parts of the country

12. Helped in writing grant proposal

13. It certainly has been continuing to be the right source of
latest info on rounds and various announcements

14. The information made available thrugh the forum help me getting
the insight on what is happening on the ground

15. I am writing a book on HIV/AIDS.  Many things learnt from the
forum will be useful

16. While developing project proposals, I collect information
from the postings

17. Learned about the drug interactions, the policy changes regarding
the drug
regulations etc

18. Made call for inputs on regional reports for UNAIDS PCB and
got productive feedback from around Asia Pacific region

19. It has helped me in two ways:  Given information on the
concerns of individuals and organization

20. I get daily information on problems faced by PLHAS in
accessing treatment

21. I teach a course Hospital and Health Management to PG
Management students and use the information  drawn from the Form in
the class room

22. Posting on latest guidelines (WHO, CDC, etc.) helps us in
updating our training curriculum

23. Its been helpful in guiding a few PLWHAs for seeking support
and guidence

24. The district Tuberculosis officer immediately came to my
clinic to offer  DOTS at my clinic after my posting on the FORUM

25. As a professional development worker in the HIV/AIDS
intervention field, my knowledge has been updated

26. The information I get through this FORUMS  is edited and
published in our NGO news tabloid, NGO-Connect,  for sharing with
other NGOs

27. Whatever information getting on related issues which is
helping me to do networking ,

28. increased awareness what is happening at the national
level

29. Gives the recent data on HIV /AIDS there by I can give the
latest information to my colleagues and clients

30. It is improving my knowledge of the pandemic in India as I
work toward greater involvement on the ground level

31. I was ignorant about ART, its availability, CD4 testing, cost
& various other associated problems. The FORUM helped me to under
stand the issues.

32. While conducting training ,utilise  and propagate the latest
happenings in the field of HIV/AIDS

33. It has been a very useful information in formulating
framework and strategy papers for intervention

34. Updating knowledge base is essential for our profession
therefore, I always have to read and learn before going to deliver
sessions

35. Based on the information I received, I was selected as one of
the yuva star for the Hath se Hath mila programme sponsored by NACO,
Doordarsan & BBC

36. Keeps me aware of other HIV/AIDS efforts country-wide, alerts
me to conference, training opportunities and professional development

37. This the first time any news media in India given adequate
focus on the unavailability of second line of ARV. This FORUM
contributed substantialy to tretment advocacy.

38. I got news of an international conference related to my work
and could attend it as a delegate

39. Change in policies help us to understand the market better at
the same time we are helping or collaborating with others through the
FORUM

40. Got more knowledge about the patenting and corporate house
squabbles over the price war , drug reactions  etc

41. Many aspects of HIV/AIDS are covered in the discussions. It
has helped me in formulating consultancy

42. I keep myself updated about all that is happening in India
and around the world on issues of HIV/AIDS through this FORUM

43. It is very helpful because most of the state updates and
national updates on HIV/AIDS  was received though this FORUM

7) Impact of the messages

After reading the messages, during the last one month, 42% visited a
website of a project, 51% down loaded a publication or online
resource, 5% requested for more information, 13% registered for an
event (training, workshop, meeting), 25% contacted other
people/organization whom they have never contacted before and 21%
responded to an advocacy call for action

8) Number of FORUMS the subscribers are member to

43%  of  the respondents are member of only this FORUM.  48%  of the
respondents are subscribers of   1-5 Forums. Only 3%  are subscribers
to  6-10 Forums and 2% are subscribers to more than 11 FORUMS .

9) The most important benefit of being on the FORUM

The most important benefit of being on the FORUM varies from getting
a job to extending friendship circle. 4% of the respondents got
their current job,  8% attended a conference, 1% received a
scholarship, 12%  got beneficial information about grants/funds, 58%
become more aware of the HIV/AIDS policies and 5% extended  their
friendship/contact net work

10) Where do the subscribers access the internet from?

48% usually access their e-mails from their office or work place. 15%
from their home,  6% from Internet Café and 25%  from home and
office.


12) Frequency of checking messages

75% of the respondents do check their e-mail daily. 13% check their e-
mails 2-3 times in a week, 5% only once in a week and 2%  only few
times in a month.

13) Ideal number of messages to be posted on the FORUM

14% of the respondents reported that too many messages are posted
daily. For  60% of the respondents  4 - 5 messages posted daily is
fine with them. 10% of  the respondents requested to post more the 5
messages in a day and 10% requested to reduce the postings to 2-3
messages in a day.

14) Nature of internet access

18% of the respondents have direct dial up net work (Slow
connection).  53% of the respondents have direct broad band
connection (ADSL, Cable, ISDN, or Faster connection). 18% of the
respondents computer is linked to an office computer network.


Additional suggestions and Recommendations from the respondents


1. People of Meghalaya, Shillong North East India are not
represented adequately on the FORUM

2. Maybe focussing on one particular topic each month and invite
response accordingly

3. Please include more clinical work which can include case
discussions as well

4. Involve more experts from clinical field

5. Allow  more right based articles

6. It would be great if more research information are gathered and
posted  on the FORUM

7. Should carry more scientific articles

8. Along with this FORUM Try to develop a print media also on
HIV/AIDS issues in
India on a Monthly basis

9. Classify the information in such a way that - messages on
specialised issued could be included

10. AIDS INDIA eFORUM has more reach than its actual membership

11. It has not gone to the grass root level where a lot of work
has been done

12. Need to increase academic information and  journal information

13. Analysis of news would be very useful

14. Good forum. Has wide reaching capacity

15. Would like to commend the forum for not charging, for its

16. Very few responses recently on clinical medicine and treatment

17. Thanks for your untiring great work

18. Need to increase participation from government

19. Very informative forum, maybe six months summary of what  has
discussed on the FORUM  will be particular use

20. UNAIDS must document the experience of this FORUM as a best
practice

21. Excellent and thoughtful initiative which is very much needed
and useful in HIV response in India.

Conclusion.

Peer to peer electronic FORUMS are an effective tool for HIV and AIDS related
information and communication among the key stake holders. Increases policy
awareness and enhances greater professional response. Cost effective mechanism
for rapid diffusion of policy and program changes. e FORUMS are contributing to 
the social capital for HIV response. Increasingly becoming a community of
practitioners, knowledge management system.

Dear Friends

NACO has planned to scaled up and strengthen ARV treatment centre
through NGOs & CBO under NACP III, from 2004 till date NACO provided
ART at Public Hospitals, during this 3 yrs many incidence their was a
shortages of ARV medicines and defunct of CD4 machines.

My concern is that if NGOs & CBO do provide ARV how can we held
accountable, if there is any problems arises.

If a NGOs or CBO defunct, who will continue their treatment?? Can we
hold the Indian Govt   accountable for this ?


Mike Tonsing
DNP+
e-mail: <dnpplus@...>

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/7051

DFID Statement to Male Circumcision

DFID Statement to Male Circumcision Meeting - Male Circumcision
Policy Meeting, March 6 -8, Montreux, Switzerland

1. The UK Department for International Development is committed
to promoting the availability and use of a comprehensive range of
evidence based methods for STI and HIV prevention for all men, women
and young people – including particularly vulnerable groups such as
men who have sex with men, adolescent girls, sex workers and drug
users.

2. The research to date on male circumcision is welcomed. Three
randomised control trials, all demonstrating consistent results,
leave us in no doubt that there is a strong protective effect for men
of male circumcision. However, key questions remain unanswered. For
example, will male circumcision make women less or more vulnerable to
HIV infection? Maria Wawer's presentation on the male to female
transmission study highlights this urgency. What will be the impact
of male circumcision on condom use? Will women's ability to negotiate
condom use with their circumcised male partners be further limited?
And at what level would reduced condom use negate the protective
effects of male circumcision?

3. As the level of debate at this meeting has demonstrated, the
transition from having new evidence, however robust, to introduction
and scale up of a new prevention method is very challenging. In doing
so we cannot and must not separate the issue of male circumcision
from the complex range of social, cultural and political issues that
determine sexual and reproductive behaviour, health and rights. There
are three key issues that DFID would particularly like to highlight:

a. Firstly, the gender dimensions of male circumcision must be
considered. For example, community and religious leaders must have a
clear understanding of the enormous differences between male
circumcision and female genital mutilation. We need to listen to
concerns that men may have about stigma and sexual expression. And we
must further our understanding of the impact of male circumcision on
women's vulnerability to HIV, STIs and unwanted pregnancy.

b. Secondly, the need to include messages about male
circumcision within processes and programmes that promote a
comprehensive menu of prevention methods. In particular, new efforts
to scale up access to male circumcision must not in any way detract
from other prevention options and should strengthen access to and use
of male and female condoms – currently the most effective prevention
method available.

c. Thirdly, scaling up male circumcision must be as part of
efforts to strengthen primary health services including efforts to
strengthen male and female SRH services and ensuring these are
central to the AIDS response.  This must not be a vertical programme.

In conclusion, while welcoming the additional evidence-based
prevention method that male circumcision provides, DFID urges
caution. Single minded pursuit of a new technology is not what is
needed. The way forward must take account of  the context, including
the gender dimensions, in which peoples' sexual relationships and
behaviour is defined; the need to improve access to a comprehensive
range of prevention methods and the importance of strengthening
delivery of health services to achieve progress in all of the health
MDGs.

Dear Forum,

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/7053

Remember a dying man never lies. Well, there are several reasons for people
committing suicide, and just because I had a reason to live, even when living
under the best care, under the best doctor in the world , Dr Michael Saag, who
has kept me alive for ten+ years, does not mean I am a happy person.

Perhaps a lot of people kin to me, did not expect me to live so long, and
promised me a lot, in the hope that I would die soon, and now are tired that I
did live.

Actually I lived so long to be able to fight for my mother, a widow, who I knew
would be trampled on, if I did not live.

So to be proud that some one lived for so long with all the knowledge in the
world, is perhaps not enough to be boastful about.

So another way to look at the rampant suicide rates in India is be introspective
and ask why they are committing suicide, for if they were content as most PLWA
in developed countries are, then they would not kill themselves.

Sincerely,
Priyadarshi Datta, PLWHA
e-mail: <thurpu@...>

Dear Forum,

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/7053

Greetings. Yes, there are People Living with HIV/AIDS are committing suicide
across the country. It is happening because of the Stigma and discrimination.

Mximum money is going to prevention part. This money is spend on mass awareness,
to reduce the stigma and discrimination. But still, stigma and discrimination is
happenning.

Why no money is spend on reducing stigma, discrminatiion  and the violation of
the rights of PLHAs?

So many sensetization programme, so many support group meeting has happend, but
still stigma and discrimination continues.

Some saty, there is law against stigma and discrimination. But why law also
fails us to protect from stigma and discrimination?

The answer is in the dely is dispensing justice by the legal institutions. When
we file  the case in the court, the case will go on  year after year, where we
need an urgent result.

Also, when we file case against somebody,he/she is starting to give more stigma
and discrimination.

This is is the background of the news of more PLWHAs committing suicide.

Regards,
Tarit.

Tarit Chakraborty
Regional Co-ordinatore(INP+)
President of BNP+(West Bengal)
email tarit34@...
Hallo-09836258928

Profiles of Attendees in the Voluntary Counselling and Testing Centre of North Bengal Medical College in Darjeeling District of West Bengal

Indian Journal of Community Medicine. Vol. 31, No. 4 (2006-10 - 2006-12)

G. K. Joardar(1), A. Sarkar(2), C. Chatterjee(1), R. N. Bhattacharya, S. Sarkar(2), P. Banerjee(2)

Abstract

Research Question: What are the socio-demographic profi les, HIV serostatus and risk behaviour pattern of the attendees in the VCTC of North Bengal Medical College? Objectives: To identify the socio-demographic profi les, HIV serostatus and risk behaviour pattern of the attendees in the VCTC of North Bengal Medical College in Darjeeling district of West Bengal. Study Design: Cross-sectional observational study. Setting: The Voluntary Counseling and Testing Centre (VCTC) in the Microbiology department attached to North Bengal Medical College in the Darjeeling district of West Bengal. Participants: All the 545 attendees attended the VCTC between August 2002 and December 2003 were included in the study. Study Variables: Age, sex, marital status, level of education, occupation, place of residence, HIV serostatus and pattern of risk behaviour in relation to HIV/AIDS. Statistical Analysis: Proportions. Results: An overall 17.06% of the VCTC attendees were HIV positive. About 84% of the HIV positives belonged to the age 20 – 39 years. For the males 51.32% and for the females 88.23% of the HIV positives were married; 52.94% of the female sero-positives were illiterate. Among the male sero-positives, 31.59% were involved in business and 30.27% in unskilled work as occupation. An overall 70.97% of the HIV positives were from the rural areas. For the male sero-positives, 81.58% were visiting the Commercial Sex Workers.

Key words: HIV serostatus, Bridge population, Voluntary Counseling and Testing Centre (VCTC), Priority Targeted Interventions.

Introduction

From a mysterious illness recognized only in the early 1980s, HIV/AIDS has established itself into a global pandemic in less than 20 years¹. Since its detection for the fi rst time in 1986, HIV infection is growing very fast in India²; the number of people living with HIV/AIDS was estimated to be 5.1 million by December 2003, and the total number of reported AIDS cases reached to 86,028 by 31st August 2004^3,4. The distribution and spread of the disease in India is highly uneven^5,3.

In order to implement the desired interventions, the epidemiology of HIV/AIDS in a particular region has to be understood specially with regards to various sociodemographic factors, level of awareness as well as pattern of risk behaviour of the population, because till date, the most effective approaches available for the prevention and control of the infection/disease are awareness generation and lifestyle changes. Voluntary counselling and testing for HIV is a cost effective intervention in preventing HIV transmission and it has become an integral part of HIV prevention programme. The Voluntary Counselling and Testing Centre (VCTC) is an entry point to care, which provides people with an opportunity to learn and accept their HIV serostatus in a confi dential environment⁶. The data generated in the VCTC, may provide important clues to understand the epidemiology of the disease in a particular region.

Material and Methods

The present study was conducted among the attendees of the VCTC of North Bengal Medical College which was attached to the Microbiology department of the college. This centre is very close to the city of Siliguri. The geographical location of the city and its role in the inter-state and international trade are crucially important with regard to transmission of HIV. It is the gateway of all the North Eastern states of India and is close to the international borders with Nepal, Bhutan, Bangladesh and interstate borders with Bihar and Sikkim resulting in high population movement (between states and between countries) as well as infl ux of a very large number of trucks with their drivers and helpers. More over large number of injecting drug users are moving into the city from neighbouring areas of Nepal and hills of Kurseong, Kalimpong and Darjeeling. As this institute is the only apex hospital in the region, the information gathered from the attendees of this centre may throw light on the epidemiology of HIV transmission in this area.

The study included all the 545 attendees who attended the centre between August 2002 to December 2003 either voluntarily or being referred from various departments of this institute. Anonymous information was collected on a pre-designed schedule by interviewing the subjects. The variables studied are age, sex, marital status, level of education, occupation, place of residence, pattern of risk behaviour and HIV serostatus of the attendees. Prior testing of the schedule was done among the clients in the STD clinic of the hospital. Following the guide lines of the National AIDS Control Organization (NACO) the counselor of the VCTC interviewed the attendees under strict confi dentiality. After pre-test counselling and after getting consent from the attendees, their blood samples were collected by laboratory technician under direct supervision of the counselor either in the department of Microbiology or in the in-patient wards of the hospital (in case of in-patients). As per the policy and strategy prescribed by NACO, the fi rst Test/ Rapid test done on the serum was Immunocomb. The persons showing negative test results were referred to the counselor in the centre. The serum samples showing positive test results were subjected to a second Test / Rapid test called Tridot. Those samples showing positive test results in the second Test also were declared HIV positives; and the persons showing negative results were advised to come after one month for review. Data was collected, compiled and analyzed using standard statistical methods.

Results

Out of 545 attendees studied, 428 i.e. 78.53% were male. With regards to the HIV serostatus of the attendees 93 out of 545 i.e. 17.06% were positive. The sero-positivity was 17.76% among males and 14.53% among the females. The distribution of the attendees by their age, sex and HIV serostatus (Table IA) shows that among the males, the majority of the sero-positives, 65 out of 76 i.e. 85.53%, belonged to the age bracket of 20 – 39 years. The same pattern of distribution was observed amongst the females as well, 13 out of 17 i.e. 76.47% seropositives belonged to the same age group of 20 – 39 years. Amongst all, about 84% of the seropositives belonged to the age group 20 – 39 years. The distribution of the attendees by their marital status (Table I-B) shows that among the males, 39 out of 76 i.e. 51.32% of the seropositives were married, and the rest of the seropositives i.e. 48.68% were unmarried. The same pattern was observed among the females; 15 out of 17 i.e. 88.23% of the seropositives being married and the rest 11.77% unmarried.

The educational level and the HIV serostatus of the attendees (Table I-C) shows that for the male seropositives 28.95% were among the illiterates and another 63.15% were among those who were educated below or up to class X standard. Whereas, for the female seropositives, 52.94% were from the illiterates.

The HIV serostatus of the attendees by their occupations (Table I-D) shows that among the males, the majority of the HIV positives i.e. 31.59% were from that group of persons who were involved in business as their occupations; closely followed by 30.27% positives from the group of unskilled workers. In case of the female attendees, most of the seropositives (88.23%) were among the housewives and the rest 11.77% were from those who were occupied in some services. Only 22 drivers attended the VCTC and among them as high as 10 were sero-positives, that is 13.15% of the male seropositives were driver by occupation.

Table I: Socio-demographic profi les and HIV serostatus of the VCTC attendees (n=545)

Table II: Pattern of Risk Behaviour and HIV Serostatus of the VCTC Attendees (n=545)

With regards to place of residence and HIV serostatus of the attendees (Table I-E), it was observed that 219 out of 400 rural attendees (i.e. 54.75%) and 109 out of 145 urban attendees (i.e. 75.17%) were from Darjeeling district itself. As far as HIV seropositivity is concerned, as a whole, most of the positives that are 66 out of 93 (70.97%) were from the rural areas; 56.07% of the rural sero positives, and 92.60% of the urban positives came from the Darjeeling district only. A rural preponderance of the HIV seropositivity was observed among the attendees from the other neighbouring districts as well.

The pattern of risk behaviour and HIV serostatus of the attendees (Table II) shows that 253 out of 428 i.e. 59.11% of the male attendees gave history of visiting Commercial Sex Workers (CSWs) and 62 out of 76 i.e. 81.58% of HIV positives among the males were from that group. For the females, 18 out of 117 i.e. 15.38% attendees were working as CSW and 6 out of 17 i.e. 35.30% of the female seropositives were from that group. Although 128 out of 428 i.e. 29.91% of the male attendees and 63 out of 117 i.e. 53.85% of the female attendees did not have or did not disclose any type of risk behaviour related to HIV / AIDS, 3.94% of the male and 5.88% of the female seropositives respectively were from the group having no risk behaviour. The husbands of 11 out of 117 i.e. 9.40% of the female attendees and the wives of 6 out of 428 i.e. 1.40% of the male attendees were already HIV positive. Among them, 5 out of 11 wives and 3 out of 6 husbands were found HIV positive. Out of 545 total attendees, the number of injecting drug users was only 8 i.e. 1.47% of the attendees.

Discussion

The findings in the present study on age distribution of HIV positives corroborates with our National fi gure, where it is observed that most of the cases (about 89%) occurred among sexually active persons aged 20 – 49 years^5,1,7. For the male attendees, the HIV positives were almost equally distributed among married and unmarried groups. Those unmarried males will soon enter their reproductive lives and infect their wives and ultimately the risk of parent to child transmission will increase.

With regard to level of education of the attendees this type of observation may be due to less number of attendees in the higher education groups; or it may be inferred that higher educational level offer some protection against HIV. Sex education is not included in our secondary school curriculum and anybody who is illiterate or educated below or up to secondary level may not have adequate knowledge for protecting himself or herself from STDs including HIV/AIDS. In general, it is observed that awareness and knowledge of HIV/AIDS remains weak in rural areas and among women5.

It was observed in 2001 that only 47% of the people in India were aware that HIV/AIDS could be prevented by consistent condom use and having one faithful uninfected partner. In the state of West Bengal, only 14% and 19% of the people respectively were aware about these two means7.

With regard to occupation, it may happen that the attendees having some businesses as occupation may get easy money and indulge in some risk behaviour that favours HIV transmission. High number of seropositives among the housewives is a matter of great concern and it might be an indication of increased HIV transmission in the area. Commercial sex and substance abuse are fi rmly entrenched in the socio-cultural milieu of the trucking industry in India and are a part of their daily life. A study in Indore (1995) observed that 94% of the truck drivers were ignorant about AIDS; and 82.9% of the senior and 43.8% of the junior drivers had history of extra-marital sex. The long distance truck drivers are a highly mobile group in whom multiple sex partners is quite common8. So it may be presumed that the population in the study area is vulnerable for a rapid spread of the infection due to its geographical location for regional, inter-state and international trade with a very high number of truck drivers moving through the area.

According to Lal, the data of the HIV sentinel surveillance does not unfold the true picture of HIV prevalence in rural areas because almost all the participating sites in sentinel surveillance are located in urban areas and the attendees most probably are urban in most settings5. The present observation of rural preponderance of HIV sero-positives is believed to be an indication of spread of HIV from the urban to the vast rural areas. This type of distribution might be due to rural location of the VCTC facilitating, easier access by the rural people; or it might indicate real increase in the HIV prevalence in the rural areas of the district through which pass some very important National Highways and where many areas of important tourist interest are located. Unprotected heterosexual intercourse is the predominant mode of transmission of HIV in India (about 84%)⁵. It was observed that sex with non-regular partners in the last 12 months was prevalent to the extent of 7% in urban and 6.3% in rural areas; and condom use rate with such kind of risky sexual relationship was 62.4% in urban and 42.9% in rural areas⁵. This population with non-regular sex partners is the "bridge population" which connects high risk to the low risk population. The larger the size of the "bridge population" the greater the risk of transmission in to the general population^5,9. The observation of the study also highlights that a large number of attendees are connecting the high-risk group (CSWs) with the low risk population (general population and housewives). And the fact remains that about two third of the male attendees are clients of the commercial sex workers and more than half of the male HIV positives were enjoying married lives.

As the present study was conducted in a clinic of a medical college hospital, the results observed are subject to bias arising from rate of reporting in the counselling and testing centre. As of now, the care seeking behaviour of our common people are infl uenced by so many factors; and it is observed that in case of sensitive issues linked with social stigma like Leprosy, STDs, HIV/AIDS there is under-reporting and underutilization of facilities. So, the probability of a different type of pictures in the community setting might not be impossible. A Community based study would have been better to avoid such type of bias.

Conclusion

The city of Siliguri and its surrounding vast rural areas with huge number of tea gardens and their workers are highly vulnerable to the rapid spread of HIV/AIDS for its geographic location, rapid urbanization, industrialization, huge population migration including cross border movements and low literacy level. Though it appears to be a Herculean task in view of the rising trend and unabated spread of HIV to the general population to achieve zero level of growth of HIV/AIDS by 2007⁵, no time should be wasted to carry out Priority Targeted Interventions among the selected high risk groups in different areas and to carry out intense IEC activities to promote behavioural changes to the favourable direction. Epidemiological studies have to be conducted in various settings to understand the role and complex relations of innumerable behavioural, social and demographic factors, which will help to interrupt and control the transmission of HIV/AIDS.

Acknowledegment

The authors acknowledge the Principal, North Bengal Medical College, Sushrutanagar, Darjeeling, and the State AIDS Prevention and Control Society, Govt. of West Bengal for allowing to undertake the study and for utilizing the data.

References

1. Park K. Park's Text Book of Preventive and Social Medicine; M/s Banarasidas Bhanot, Jabalpur (India), 2002; 17th. Edition: 259 – 267 and 314 – 316.
2. National AIDS Control Organization, Ministry of Health and Family Welfare, Govt. of India, New Delhi: HIV Testing Manual - Laboratory Diagnosis, Biosafety and Quality Control.
3. An Overview of the Spread and Prevalence of HIV/AIDS in India. Available from website: www.naco.nic.in/nacp/bss1. pdf
4. Surveillance for AIDS cases in India (Period of Report – from 1986 to 31st August, 2004). Available from website: www.naco. nic.in/nacp/bss1.pdf
5. Lal S. Surveillance of HIV/AIDS in India (Editorial). Indian Journal of Community Medicine, 2003; XXVIII (1): 3 -9.
6. National AIDS Control Organisation. Ministry of Health and Family Welfare, Govt. of India New Delhi: Voluntary Counseling and Testing: 01 – 08.
7. Kumar S. Suresh, Project Director, West Bengal State AIDS Prevention and Control Society; Unpublished presentation in the Annual State Conference of IAPSM W.B. Chapter,on 26.06.2004 at North Bengal Medical College, Darjeeling.
8. Bansal R. K. Truck Drivers and Risk of STDs including HIV. Indian Journal of Community Medicine, 1995, XX (1-4): 28 – 30.
9. International Institute of Population Science (IIPS). India National Family Health Survey (NFHS 2) – Key Findings, Mumbai: IIPS, 1998 – 99.

(1.) Deptt. of Community Medicine,
(2.) Deptt. of Microbiology, North Bengal Medical College.
Received: 3.11.04

[March 24th. Today is World TB Day.  The day marks 125 years since
the cause of TB was first discovered. To reviw the global TB report card vist
the following url.
http://www.healthdev.org/eforums/Editor/assets/publications/PDFs/Global_TB_RC_20\
07_final.pdf  Moderator]
___________________________________

Drug resistance threatens India's battle against TB

by Parul Gupta
Drug resistance is emerging as one of the biggest challenges in
India's battle against tuberculosis, the major killer of adults in
the South Asian nation, experts warn.

Three percent of all new TB cases in India and roughly 14 percent of
patients undergoing treatment for the disease have developed
resistance to drugs, studies estimate.

Experts have called for upgraded facilities to better diagnose drug-
resistant strains of TB, a disease which spreads through coughing and
sneezing and usually infects the lungs.

"We have limited facilities for detecting drug-resistant TB in India,
which poses challenges in fighting the disease," said Nani Nair,
regional advisor on tuberculosis with the World Health Organisation.

"We will have another 24 laboratories to detect the drug-resistant
strain in the next five years," said Nair, ahead of World TB Day on
Saturday.

In the meantime, just three laboratories, apart from medical colleges
and private hospitals, are equipped to diagnose such strains, she
said.

India reports some 1.8 million new cases every year -- the highest in
the world -- and 1,000 deaths daily despite having one of the world's
most successful anti-TB programmes.

Doctors say mycobacterium tuberculosis, which causes the disease,
develops resistance to all or some of the drugs when patients give up
their treatment mid-way after visible signs of recovery.

"This form of TB is a very big concern for us because it is more
difficult and more expensive to detect and treat," Nair said.

Even though TB drugs are free in India, many poorer patients abandon
medication because of the difficulty of reporting to the doctor for
supervised treatment at the same time as continuing to work.

Poor nutrition also makes recovery longer and more difficult.

Public health experts said they would use World TB Day to push for
the development of improved drugs and diagnostic techniques. The day
marks 125 years since the cause of TB was first discovered.

"The technique we are using today for primary diagnosis is 125 years
old now. It's a shame we have not made enough investments because
it's a poor man's disease," said Bobby John, who heads advocacy body
Global Health Advocates.

"Multi-drug resistant (MDR) TB is emerging as one of the biggest
challenges in India, but we have not even started reporting it
fully," John said.

Nair said more effective drugs being tested for faster treatment
were "not going to become a reality before another five to 10 years."

Health experts say India also needs to integrate its facilities for
treating TB and HIV-AIDS.

The weakened immunity of people with HIV makes them most vulnerable
to the disease and India has 5.7 million people living with HIV-AIDS -
- the world's biggest caseload.

"A person with HIV is at considerably higher risk of contracting TB,
but there is not enough cognizance of this problem in India," John
said.

The country has one of the world's largest Directly Observed
Treatment Shortcourse (DOTS) programme -- recommended by the WHO for
TB treatment -- covering its one billion-plus population.

"The programme was reaching less than 200 million people less than
seven years ago. It's the most underplayed public health milestone in
the world," John said.

Under the programme, the country has reached its target treatment
rate of 85 percent. But its detection rate, stands at under 66
percent, behind the target figure of 70 percent.

"The biggest challenge now is to be able to sustain the current
impetus of the marvellous job India has done," said WHO's Nair.

http://www.france24.com/france24Public/en/administration/afp-
news.html?id=070323034241.csxsqkmi&cat=null

Dear FORUM,

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/7051

I think Dr. Gupta raised some very important issues that ought to be considered
before launching a mass circumcision campaign anywhere.

In a recently published article, my colleagues and I reported that circumcised
male and female virgins and adolescents in Kenya, Lesotho, and Tanzania are
_more_ likely to be infected with HIV than their uncircumcised counterparts.

There are widespread observations of unhygienic circumcision practices in
sub-Saharan Africa, and the available evidence suggests that HIV transmission
may occur through circumcision-related blood exposures.  Clinical settings there
are also plagued by poor infection control, so medical circumcision may not be
any guarantee for hygienic care.  This article is available on request from
http://www.interscientific.net/AOE2007.html.

We found, as have many others, that circumcised adults (both men and women) were
less likely to be HIV infected than uncircumcised adults.  This difference in
the direction of the relationship (circumcised more likely to be infected among
adolescents, circumcised less likely to be infected among adults) may be due to
circumcision-related HIV mortality (that is, most persons infected during
circumcision in adolescence dying before reaching middle to late adulthood).

The circumcision trials that you mentioned consistently demonstrated substantial
reductions in genital symptoms following circumcision.

As a result, circumcised men may also be less likely to seek treatment for
genital symptoms and consequently receive fewer blood exposures to HIV from
unhygienic care (such as with unsterilized, reused syringes).

The three trials demonstrated that circumcision in presumably sterile conditions
decreased the rate at which men acquired HIV.  However, the mechanism of this
effect is unclear.  The trial investigators have argued that the effect is due
to physiology.  The most frequently cited physiologic mechanism is the
elimination of foreskin with its dense population of Langerhans cells.  These
cells have been thought to be especially vulnerable to HIV infection, but
research published two weeks ago showed that these cells actually produce a
protein that strongly _protects against_ HIV infection (see
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstra\
ctPlus&list_uids=17334373&query_hl=2&itool=pubmed_docsum).   Altogether, the
findings I've mentioned here call into question the physiologic basis of the
effect observed in the trial.  It remains for further research to identify the
mechanism, but some other possibilities might be reduced exposure to
  unhygienic formal or informal medical care (as a result of reduced genital
symptoms) and changes in sexual repertoire after circumcision (perhaps shifting
from anal sex to vaginal sex; types of sex apparently not measured in the
trials).

The uncertainties about circumcision also highlight the broader issue of
nonsexual transmission of HIV.  You have nicely outlined several aspects of such
transmission on one of your web pages
(http://t8web.lanl.gov/people/rajan/AIDS-india/MYWORK/blood.6.00.html).

Mariette Correa and David Gisselquist, contributors to this list, have also
published a number of informative articles and reports on this dimension of the
epidemic in India (see, for example,
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstra\
ctPlus&list_uids=17062177&query_hl=4&itool=pubmed_docsum).

Devon Brewer
e-mail: interscientific@...
www.interscientific.net