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Can the burden of pneumonia among HIV-infected children be reduced?

Prakash Mohan Jeena (a)

Of the approximately 2.1 million children who are infected with human
immunodeficiency virus type 1 (HIV-1),1 more than 80% will develop a
respiratory illness sometime during the course of their disease.2

The prevalence of HIV-1 infection among African children admitted for
very severe pneumonia (under the WHO case definition) varies from 55%
to 65% and is associated with a case fatality rate of 20% to 34%;
three- to six-times higher than children who are not infected with
HIV.3,4

In infancy, pneumonia caused by Pneumocystis jiroveci is often the
first HIV/AIDS indicator disease that prompts HIV testing and,
consequently, early antiretroviral treatment for those infected.5

Approximately 2 million children less than 5 years of age die of
pneumonia each year in countries with a high prevalence of HIV. The
standard case management guidelines for pneumonia recommended by WHO
for use in areas with low HIV burdens are less effective in areas
where HIV burdens are high.6

Modifications to these guidelines have been suggested, but their use,
as reported in a recently published study of children with very
severe pneumonia, resulted in a 45% treatment failure rate among HIV-
infected infants in tertiary care settings.4 Polymicrobial infections
with Staphylococcus aureus, nontyphoidal Salmonella spp. and other
Gram-negative pathogens, Mycobacterium tuberculosis, P. jiroveci,
cytomegalovirus and other viruses were commonly seen among the
treatment failures and carried a greater than 10-fold risk of a
poorer outcome.

Randomized controlled studies of alternative antimicrobial agents
that are active against some of the pathogens identified among these
treatment failures are urgently required.

A second major challenge for standard case management in the HIV era
is to develop a management guideline to care for the largest group of
HIV-affected children: HIV-exposed but HIV-uninfected children, who
are at increased risk of acquiring pneumonia. Such children, who live
in close contact with HIV-infected persons who persistently harbour a
multitude of different pathogens, are at higher risk of pneumonia
treatment failure than HIV-unexposed control children; however, the
risk of an adverse outcome is lower than for HIV-infected children.7

Studies on the impact of pneumonia on HIV-exposed but HIV-uninfected
children are essential.

The other major intervention to reduce pneumonia-related morbidity
and mortality among HIV-infected children requires the implementation
of preventive strategies. Routine immunizations against Streptococcus
pneumoniae, Haemophilus influenzae and varicella are safe and
effective in HIV-infected children, even though their primary
immunological response is inferior and they experience faster decay
in immunological memory. Despite the lower efficacy of the conjugate
pneumococcal (65% versus 83%) and H. influenzae type b vaccines (55%
versus 91%) against invasive disease in HIV-infected and HIV-
uninfected control children, respectively, introduction of these
vaccines would considerably reduce the 1.6 million pneumococcal and
300 000 H. influenzae deaths that occur each year.8–10

Other preventive strategies, such as the provision of co-trimoxazole
prophylaxis against bacterial and P. jiroveci infections, improvement
in the provision of prevention of mother-to-child transmission
(PMTCT) interventions and early use of highly active antiretroviral
therapy (HAART) require urgent scaling-up. In a randomized controlled
study of co-trimoxazole prophylaxis versus placebo in HIV-infected
older Zambian children, a significant reduction in the hazards ratio
for death of 0.57 (95% confidence interval: 0.43–0.77) was seen in
the treated group.11

Although there is undoubted benefit in providing co-trimoxazole
prophylaxis to HIV-infected children, its widespread implementation
does carry risks such as development of resistance to a drug used for
treating P. jiroveci pneumonia.

This needs to be studied urgently as ineffective treatment of these
conditions could increase mortality substantially. The effective
implementation of PMTCT programmes, involving at least dual
antiretroviral therapy and effective nutritional advice, will help to
reduce to less than 4% the incidence of transmission of HIV to
newborns and infants.12

Such a reduction is likely to have a significant impact on cutting
the prevalence of pneumonia among HIV-infected children. Furthermore,
use of HAART with HIV-infected children has been associated with a
fourfold reduction in the rate of opportunistic infections and a
threefold reduction in hospitalizations.13

The role of nutritional inventions, such as exclusive breastfeeding
and zinc supplements, in the prevention of pneumonia among HIV-
infected children needs to be explored more thoroughly.

In conclusion, significant attention has to be paid to revising the
standard case management guidelines for HIV-infected children with
pneumonia through properly conducted randomized controlled studies.

The implementation of preventative strategies that include co-
trimoxazole prophylaxis, pneumococcal and H. influenzae type b
vaccinations, PMTCT programmes and early introduction of HAART carry
the greatest immediate hope for helping these children. There is a
need to rapidly scale up these measures globally.

References

1. UNAIDS epidemic update: special report on HIV/AIDS: December
2007. Geneva: UNAIDS/WHO; 2007. Available from:
http://whqlibdoc.who.int/unaids/2007/9789291736218_eng.pdf [accessed
on 3 April 2008].

2. UNAIDS epidemic update: December 2005. Geneva: UNAIDS/WHO;
2005. Available from:
http://www.unaids.org/epi/2005/doc/EPIupdate2005_pdf_en/epi-
update2005_en.pdf [accessed on 3 April 2008].

3. Nathoo KJ, Gondo M, Gwanzura L, Mhlanga BR, Mavetera T, Mason
PR. Fatal Pneumocystis carinii pneumonia in HIV seropositive infants
in Harare, Zimbabwe. Trans R Soc Trop Med Hyg 2001; 95: 37-9 doi:
10.1016/S0035-9203(01)90325-6 pmid: 11280062.

4. McNally LM, Jeena PM, Gajee K, Thula SA, Sturm AW, Cassol S,
et al., et al. Effect of age, polymicrobial disease and maternal HIV
status on treatment response and cause of severe pneumonia in South
African children: a prospective descriptive study. Lancet 2007; 369:
1440-51 doi: 10.1016/S0140-6736(07)60670-9 pmid: 17467514.

5. Graham SM, Mtitimila EI, Kamanga HS, Walsh AL, Hart CA,
Molyneux ME. The clinical presentation and outcome of Pneumocystis
carinii pneumonia in Malawian children. Lancet 2000; 355: 369-73 doi:
10.1016/S0140-6736(98)11074-7 pmid: 10665557.

6. Jeena P, Thea DM, Macleod MB. the APPIS Group. Failure of
standard antimicrobial therapy in children aged 3-59 months with mild
or asymptomatic HIV infection and severe pneumonia. Bull World Health
Organ 2006; 84: 269-75 pmid: 16628299.

7. Jeena PM, Minkara AK, Corr P, Bassa F, McNally LM, Coovadia
HM, et al., et al. Impact of HIV-1 status on the radiological
presentation and clinical outcome of children with WHO defined
community-acquired severe pneumonia. Arch Dis Child 2007; 92: 976-9
doi: 10.1136/adc.2006.104406 pmid: 17595201.

8. Klugman KP, Madhi SA, Huebner RE, Kohberger R, Mbelle N,
Pierce N. for the vaccine trialists group. A trial of a 9valent
pneumococcal conjugate vaccine in children with and without HIV
infection. N Engl J Med 2003; 349: 1341-8 doi: 10.1056/NEJMoa035060
pmid: 14523142.

9. Madhi SA, Petersen K, Khoosal M, Huebner RE, Mbelle N,
Mothupi R, et al., et al. Reduced effectiveness of Haemophilus
influenzae type b conjugate vaccine in children with a high
prevalence of human immunodeficiency virus type 1 infection. Pediatr
Infect Dis J 2002; 21: 315-21 doi: 10.1097/00006454-200204000-00011
pmid: 12075763.

10. Centers for Disease Control and Prevention. Vaccine
preventable deaths and the Global Immunization Vision and Strategy,
2006-2015. MMWR Morb Mortal Wkly Rep 2006; 55: 511-5 pmid: 16691182.

11. Chintu C, Bhat GJ, Walker AS, Mulenga V, Sinyinza F, Lishimpi
K, et al., et al. Co-trimoxazole prophylaxis against opportunistic
infections in HIV infected Zambian children CHAP: a double blind
placebo trial. Lancet 2004; 364: 1865-71 doi: 10.1016/S0140-6736(04)
17442-4 pmid: 15555666.

12. Lallemant M, Jourdain G, Le Coeur S, Mary JY, Ngo-Giang-Huong
N, Koetsawang S, et al., et al. Single dose perinatal nevirapine plus
standard zidovudine to prevent mother-to-child transmission of HIV-1
in Thailand. N Engl J Med 2004; 351: 217-28 doi: 10.1056/NEJMoa033500
pmid: 15247338.

13. Nesheim SR, Kapogiannis BG, Soe MM, Sulivan KM, Abrams E,
Farley J, et al., et al. Trends in opportunistic infections in the
pre- and post-highly active antiretroviral therapy eras among HIV-
infected children in the Perinatal AIDS Collaborative Transmission
Study, 1986-2004. Pediatrics 2007; 120: 100-9 doi: 10.1542/peds.2006-
2052 pmid: 17606567.

Affiliations

a. Department of Paediatrics and Child Health, University of Kwazulu-
Natal, Private bag X1, Congella, Durban 4013, South Africa.

doi: 10.2471/BLT.08.053223
WHO Bulletin. Volume 86, Number 5, May 2008, 321-416
http://www.who.int/bulletin/volumes/86/5/en/index.html

How to Interpret CD4 and CD8 Test results

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/8740

Several laboratory tests are routinely performed as part of standard
HIV patient management. These include tests related to drug toxicity,
opportunistic infections, HIV viral status (viral load), and immune
competency (CD4).

The CD4 test measures the concentration of CD4 positive (CD4+) T cells in the
body. CD4+ T cells or T-helper cells are key components of the immune system
that help it identify bacteria and viruses. In a healthy individual, the normal
concentration of CD4+ T cells can range from 500 to 1400 cells/mm3.1

One of the hallmarks of HIV infection is the depletion of CD4+ T
cells. This depletion impairs the body's immune system and allows
opportunistic diseases to cause infections. Simply put, the lower the
concentration of CD4+ T cells, the higher the risk of developing
opportunistic infections. Late-stage HIV infection is defined by a
CD4 count of <200 cells/mm3.

One of the difficulties in interpreting CD4 test results is the
inherent variability of the results.

An individual's CD4 count can vary for numerous reasons other than the status of
HIV infection. CD4 counts are influenced by time of day, the season of the year,
common infections, surgery, and some drugs including corticosteroids. CD4 counts
are usually lowest at midday and highest in the evening.2 Infections and major
surgery also decrease CD4 counts.

Corticosteroids can drastically lower CD4 counts. Pregnancy, age,
gender, and stress have only minimal effects on CD4 counts.

In the management of HIV patients, CD4 tests are typically performed
every 2 to 6 months depending on whether or not the patient is on
therapy. Like HIV viral load results, CD4 test results are usually
serially monitored, which means that the current result is compared
to historical results to identify any trends. If a result is
inconsistent with any prior trends, the test should be repeated.3

CD4+ T cell concentrations can be reported in two different ways:
absolute CD4 counts and percent CD4 (%CD4).

Absolute counts are  reported as cells per mm3; %CD4, which is the percent of
CD4+ T cells in a total white blood cell count, is sometimes used because it
varies less than the absolute count.

Table 1 shows the correlation  between absolute and percentage counts.

Frequently, there will also be information about CD8+ T cells (T-
suppressor cells) in the CD4 test results.

T-suppressor cells work in  conjunction with T-helper cells (CD4+ cells).
T-helper cells help the immune system identify bacteria and viruses;
T-suppressor cells are  involved in stopping the immune response. CD8+ cells are
measured at the same time as the CD4+ cells. In healthy adults, a normal CD8 
count is between 375 and 1100 cells/mm3. Unlike CD4+ T cells, CD8+ T cells have
not been found to correlate with disease outcome.

However, the ratio of CD4+ cells to CD8+ cells (T-helper cells/T-
suppressor cells) may be used as a monitoring tool for immune status
much like absolute CD4 counts are used. The normal ratio of CD4+
cells to CD8+ cells is around 1 to 2 CD4+ T cells to every CD8+ T
cell. Therefore, drops in the CD4/CD8 ratio, CD4 percentage, or
absolute CD4 counts are all indications of a depletion of T-helper
cells in the immune system.

Clinically, the concentration of CD4+ T cells, measured by absolute
CD4+ cell counts, %CD4 cells, or CD4/CD8 ratio, is essential in HIV-
positive patient management. In untreated patients, CD4 counts drop
significantly each year. By contrast, CD4 counts will typically
increase with successful antiretroviral therapy. Counts can increase
as much as 50 cells/mm3 4 to 8 weeks after starting therapy.4

Therefore, the concentration of CD4+ T cells is a critical tool when
making decisions about when to start antiretroviral therapy, and
since depletion of T-helper cells increases the risk of opportunistic
infections, CD4 counts are also needed to make decisions about
therapies to prevent opportunistic infections.5,6

Timothy M Alcorn, PhD is the Executive Director of Molecular
Pathology for Esoterix, Inc.

The CD-4 count in healthy adults ranges from 500 to 1,500 cells per
cubic millimetre of blood. In HIV infected people, it goes down by 60
cells per cubic millimetre of blood per year as HIV progresses. ART
is administered when an HIV-positive person registers a CD-4 count
under 200.


Dr Diwakar Tejaswi
Patna, India
e-mail: <diwakartejaswi@...>
--------------------------------------------

References

Laurence J. T-cell subsets in health, infectious disease, and
idiopathic CD4+ T lymphocytopenia. Ann Intern Med 1993; 119;55â€"62.

Malone JL, Simms TE, Gray GC, et al. Sources of variability in
repeated T-helper lymphocyte counts from human immunodeficiency virus
type 1â€"infected patients: total lymphocyte count fluctuations and
diurnal cycle are important. J Acquir Immune Defic Syndr 1990: 3
(2):144â€"151.

Bartlett J. 2003 Medical Management of HIV Infection. Johns Hopkins
Press, 2003: p.18.

Blankson JN, Gallant JE, Quinn TC, et al. Loss of HIV-1-specific
immunity during treatment interruption in two chronically infected
patients. JAMA 2002, 288(2); 62â€"64.

Mellors JW, Munoz A, Giorgi JV, et al. Plasma viral load and CD4+
lymphocytes as prognostic markers of HIV-1 infection. Ann Intern Med
1997, 126(12); 946â€"954.

Egger M, May M, Chene G, et al. Prognosis of HIV-1-infected patients
starting highly active antiretroviral therapy: a collaborative
analysis of prospective studies. Lancet

Dear Friends,

Greetings.

This is to share an example of an Advocacy  work done by the member of BNP+.

One of our district net work member is an Auto Driver. But, just some months
back he was denied to drive the Auto by the owner of his Auto riksha because of
his HIV status. He became jobless. He was the only earning member of his family.

He discussed this matter with another member of that particular District. To
know the details of the matter, that member directly went to the Auto Owner and
requested him to give back the Auto driving job otherwise his family would be in
great danger.

He  informed the Auto ownen that If he is not willing to listen to this request,
they would mobilize the State PLHIV network who may takeup needful action
against the owner of the Auto.

Then and there that owner called him and gave the Auto to drive.

Farzana Begum,
Vice-President BNP+(West Bengal)
Executive Member of NWF of INP+.
Mobile Number:-09830606804
e-mail: <farzana_bnp@...>

APAC VHS USAID – IRT PMC INSTITUTIONAL CARE PROJECT

Invites application from the interesting candidates for the following
posts in the PLHA care team of IRT PMC, Erode Dt
Project period May2008 to March 2009, likely to be extended
All appointments of the project are temporary .

Training coordinator, data manger cum M&E officer -1 no

Primary duties:

• He / She is training  coordinator & the M&E person for the
project
• Compile  & consolidate all the data regarding the project
• Report writing of the Project as a whole
• Assist in logistical aspects of training programs.
• Ensures availability of training materials (modules-
trainers/participants)
• Design and implement the reporting system for the
clinical ,training, outreach programs
• Setting up the database for the hospital setting
• Setting up the backup for the database
• Managing the server problems and issues
• Updating the database according to the change in hospital
procedures and any guidelines
• Training the staffs on the database management
• Available on call for any issues or errors encountered in the
database
• Monitors the data collected by data entry operators/OSS/Peer
counselors
• Ensures quality of data collection & reporting
• Organize District level dissemination program & support group
meeting with local NGOs, HCPs, in house training and follow-up
activities by the assistance from OSS & other staff.

Qualifications: Masters degree preferably with social / management
background, with excellent computer skills; excellent training
coordination skills & Good interpersonal skills.

Junior assistant -1 no

Primary duties:

He/ she has to  compile & provide  all the  project reports
in meetings ,day to day activities  to Dean through  PCO

She /He has to provide  official assistance to all the staff
members of the program

Welcome and assist visitors/ trainees

Assist with training coordinator with all of his activities
in particular

Qualifications: Basic qualification, Higher level type writing
English/Tamil, accounts, computer skills MS- OFFICE; Have
knowledge/interest in HIV/AIDS; Good interpersonal skills

Interested persons send the application,
on or before May 7th, 2008, to

Dean,
IRT Perundurai Medical College,
Perundurai.
Erode DT -638 053
irtpmc@...

Dear Members!

The Treatment Monitoring & Advocacy Project which is home to the Missing the
Target series of reports on AIDS service delivery is engaged in a research
project called “CCM Advocacy Project”. It is a research project on civil society
engagement in Global Fund Country Coordinating Mechanisms (CCM).

The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) was created to
increase resources to fight three of the world's most devastating diseases, and
to direct those resources to areas of greatest need. As a partnership between
governments, civil society, the private sector and affected communities, the
Global Fund represents an innovative approach to international health financing.

About Country Coordinating Mechanism (CCM)

Country Coordinating Mechanisms are central to the Global Fund's commitment to
local ownership and participatory decision-making. The CCM submits grant
proposals to the Global Fund based on priority needs at the national level.
After grant approval, they oversee progress during implementation. Country
Coordinating Mechanism include representatives from both the public and private
sectors, including governments, multilateral or bilateral agencies,
non-governmental organizations, academic institutions, private businesses and
people living with the diseases. For each grant, the Country Coordinating
Mechanism nominates one or a few public or private organizations to serve as
Principal Recipient.

About CCM Advocacy Project

The CCM Advocacy project is a seven country project: Argentina, Jamaica,
Cambodia, Uganda, Cameroon, Romania, and India. The aim of the project is to
increase meaningful participation of civil society in Global Fund Programming at
the country level and to study the role of civil society in the CCM. The project
is not focused solely on issues of civil society representation on CCM, but more
broadly on the ability of civil society to have significant impact on improved
Global Fund Programming.

We are happy to inform you that The India HIV/AIDS Alliance has been selected to
take up the CCM Advocacy Project in India.

A research template was developed in consultation with the seven country
research teams, and this template will be used to collect data as part of the
research study.

Research will include review of relevant documents and interviews with
approximately 20 individuals, including representatives from government, the
national AIDS council, civil society, affected populations, the principle
recipient, and other individuals.

The timeline for this research study is from April – July, 2008. The India
HIV/AIDS Alliance will engage in interviews, data collection, preparation of a
report, and media work.

The overall project will release a comprehensive report in July or August.

This report will be used as a advocacy tool at various levels to influence the
CCM for enhancing civil society participation in CCM.

In this context, we would like to invite larger civil society participation as
The Global Fund is the largest donor to fight against HIV/AIDS, and it is our
collective responsibility to see that the funds are utilised in realizing that
goal.

Hence, your participation is crucial in this research as the research findings
will be collated, analysed, and developed into a report. We are aiming to use
the findings as an advocacy mechanism at various levels to enhance civil society
participation in The Global Fund programming. We take this opportunity to
request you to respond to the central questions of the research which are as
follows:

1) How civil society members are selected for CCM membership?

2) Are they able to be meaningfully involved in program design and oversight?

3) What degree they represent the perspectives of broader civil society?

4) What supports are available to promote more effective civil society
engagement in CCM?

5) Is civil society able to have direct impact in improving the quality and
effectiveness of Global Fund-supported programs?

6) What are examples of civil society having this impact through CCMs, and what
factors made this possible?

7) What can be done to foster civil society’s role as an advocate for improved
Global Fund programming through its involvement in the design, monitoring and
evaluation of GF programs?

Your responses will be compiled and analysed to prepare a report.

Please post your responses very briefly and clearly for the analysis purpose.
The answers will be kept confidential with Alliance and results will not be
linked to specific respondents in the report.

Also, please mention your name, organisation’s name, place, as these details are
mandatory. No responses will be considered for analysis without the above
mentioned details.

For any clarifications, please write to pbuggineni@....

You may also reach me at 011-41633081.

Padma

Padma Buggineni
Senior Policy Officer
India HIV/AIDS Alliance
Kushal House, Third Floor
39 Nehru Place
New Delhi 110019. India
e-mail: <buggineni_padma@...>

Dear Forum,

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/8606

Mr. Anirudh Brahmachari has well clarifed the the fundemantal issues. The issue
is not about experience and understanding of issues, but about equity. If we
only look at the expertise, adequate experience  and academic qualification in
order to fill in the position, then let us not use the term 'GIPA' - Two decades
ago, the movement of people with disabilitites used to say 'Nothing about us
without us'.

The same should be applicable here and the state mechanisms should provide such
opportunities.  Now that we have an opportunity, other NGOs, CBOs, and People's
network who claim to be associated closely with the constituency should
facilitate such environment.

Thanks,

Saraswathi Rao
e-mail: <sara510@...>

69 to give new lease of life to HIV patients this summer

Express news service

Pune, April 17 69 the Health Food Restaurant, with the tag-line 'Living
Life in Every Breath' is opening up on April 19. 69 has opted to be one
of the first HIV Positive restaurants in the city, taking the lead in
supporting the Wake Up Pune campaign.

HIV Positive is positive about education, positive about awareness,
positive about support as is the motto of the Wake Up Pune campaign,
says a statement issued here.

Neelu Punn, Director Maharashtra of Heroes Project, a Wake Up Pune
partner, will present the owner Ved Jitesh with the HIV Positive
Certificate. The restaurant is located at Dhole Patil Road and hopes to
give a new lease of life to persons affected by the virus

http://www.expressindia.com/latest-news/69-to-give-new-lease-of-life-to-
HIV-patients-this-summer/298259/

Dear forum

Can any one say the differences between CD4 Count and CD4 Percentage?

During our HBC programs for the infected children we found from their
medical record CD4% rather than CD4 count.

What is the minimum % to start ART medicines for the infected people?

-Lucien-
Socialworker
e-mail:  <fmlucy@...>

Phone-in programme on AIDS

Special Correspondent

TIRUCHI: The Tamil Nadu AIDS Control Society has launched a live
phone-in radio programme on HIV/AIDS from April 22.

The programme would be broadcast simultaneously by the Chennai,
Tiruchi, Coimbatore, Karaikal, Kodaikanal, Nagercoil, Pondicherry and
Tirunelveli stations of the All India Radio for 26 weeks. The
programme would be broadcast on all Tuesdays between 1 and 1.30 p.m.
and listeners could raise queries to be answered by experts in the
studio.

The programme would cover all aspects of HIV/AIDS and the focus would
be on prevention of mother-to-child transmission of the virus. The
programme would seek to dispel the myths and misconceptions about
HIV/AIDS and provide information on anti-retro viral therapy,
testing, blood safety and rehabilitation programmes.

The society would award prizes of radio sets to listeners who give
correct answers to questions asked at the end of every episode. At
the end of the series, listeners who give the maximum number of
correct answers would get a grand prize of free return tickets to
Singapore.

http://www.thehindu.com/2008/04/28/stories/2008042860870300.htm

Italy to help India fight AIDS, drug menace

Calcutta News.Net, Friday 25th April, 2008 (IANS)
Italy will provide financial assistance to fight HIV/AIDS and drug
addiction in Tripura, Punjab and Tamil Nadu, an Italian official said
here Friday.

'The Italian government has decided to provide Rs.30 million through
the Red Cross societies of India and Italy to deal with AIDS, drug
addiction, tuberculosis, malaria, water borne disease, various public
health problems and disaster management,' said Antonio Armellini,
Italian ambassador to India.

A Memorandum of Understanding (MOU) has been signed between the Red
Cross Societies of India and Italy to implement this one year long
project, beginning next month.

'Drug abuse has become a major challenge in Southeast Asia and it
does not recognize borders,' Armellini told journalists.

'Students, professionals, vehicle workers, and army and para-military
troopers are the target group of this project,' said Matteo Ciarli,
country coordinator of the Italian Red Cross.

Armellini said: 'India and Italy have done business worth $6.5
billion during last year and the former is in the advantageous side
in doing the business.'

'Both the countries are doing business in automobiles, fertilizers,
leather, chemicals, information technology and food processing
sectors,' he said.

http://www.calcuttanews.net/story/352311

Dear all,
The latest on the Sitamarhi incident.
Alok

Dear friends,

I am looking for an institute/organisation that conducts management
training programmes on HIV/AIDS and TB for Mid level Programme
Managers working in NGOs.

I am interested in doing this training on HIV/AIDS, TB and confection
along with my colleagues. An information sharing by community members
will help me.

Look forward to hearing from you all. You may also reach me at
farhadali1@...

best regards

Farhad Ali
Programme Manager
Bihar Health in Action Project
LEPRA Society
Patna - Bihar
Mobile: 9234805443
farhad ali <farhadali4u@...>

Attention Dear Forum,

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/8719

In order to generate a response from the Government to end the
unhealthy trend in VCTC,PPTCT,government hospitals,and other
Government Departments the Positive Women¡¦s Network (PWN+) organized
the State level Advocacy workshop & Event "To address the needs of
Women Living with HIV/AIDS from 7 Districts of Andhra Pradesh".

This consultation aimed at improving access of Women living with
HIV/AIDS to the programmes and schemes of various government
ministries and departments in Andhra Pradesh and share experiences
and issues from the voice of WLHA to seek multi sectoral response.

Mr.Kalidhas from APSACS participated in the Event and we would like
to take this opportunity to thank him for his valuable contribution
which was motivated both the WLHA and other Government officials
Participated.

Positive Women Network suggested the following achievable
Recommendations to improve the government systems and to encourage
the WLHA in Accessing Schemes and programmes of the government in
that Event and submitted to the Departments:

1) Practical updated and attitudinal HIV-related training,
women and children-related treatment training and sensitization
programmes must be conducted for all Government department staffs
and Administrators.

2) Post-Graduate students of Medicine should be given hands-on
training to handle HIV/AIDS- related conditions so that they are
well-equipped to deal with such cases in future.

3) Codes of Ethics and professional conduct in healthcare
provision should be put in place with appropriate forms for
redressal of professional violations.

4) Adequate supplies of Universal Barrier Precautions and basic
infrastructure must be made available in hospitals and labs for
infection control, hygiene and the safety of healthcare providers.

5) Updated information on the disease, medication, dosage,
testing, precautions and preventive measures and medicines for women
and adherence should be readily available to healthcare workers.

6) Adequate supplies of culturally relevant IEC materials on
updates should be available to healthcare workers.

7) Better referral and co-ordination mechanisms between
departments for reducing stigma and discrimination.

8) Well-trained counselors equipped with knowledge on handling
health issues faced by women and children living with HIV.

9) Testing guidelines need to be developed for children
affected by HIV. Child-friendly
Information on ART and HIV should be developed.

10) Increase the amount of Widow Pension, and priority is needed
in moving the applications to ensure it for WLHA.

11) Necessary certificates need to be provided for WLHA in a
priority basis to access the schemes of the government.

12) Support for Women Self-Help groups formed by WLHA is needed.

13) Sensitization program for all government departments is
needed to understand the concerns of WLHA.

Following to this Advocacy Event we would like to salute the "BE
BOLD" Campaign and express our happy and thanks to APSACS for taking
important decisions on VCTC and PPTCT Services and Testing Kits for
Hospitals which were recommended in the event.

Also we would like to request to the Respected Project Director and
APD to derive certain mechanism with the consultation of Networks to
bridge the gaps between WLHA-APSACS- Other Government Departments-
to access the schemes available and this is the right team to do
that.

Once again Thanks to APSACS on behalf of Women Living with HIV/AIDS.

In Solidarity,

Positive Women Network (PWN+)
Parsn Paradise 109, C Block, A-3, 4rth Floor,
G.N.Chetty Road,
T.Nagar, Chennai-17
Phone-044-28342801
E-MAIL: <suseelaanand@...>

Monday, April 28, 2008

http://pib.nic.in/release/release.asp?relid=38114

Rehabilitation policy needed for HIV positives, says Jagjit Singh

VERINDER SAREEN, Friday, 18 April 2008

NAWANSHAHR: Punjab Networking of Positive People Society, a Ludhiana-
based group of around 200 persons working for HIV-affected persons,
here Friday demanded a comprehensive rehabilitation policy for the
HIV and AIDS infected persons in the state.

Talking to PunjabNewsline.com here at Drug De-addiction Centre,
society's founder Jagjit Singh Mann said that victims of these deadly
diseases required more attention of the state government than they
were being given at the moment.

Besides providing them free bus facility, at least when they are
visiting the ART Centres for getting their dose of medicines, HIV
testing should be made mandatory while issuing of driving licenses
and registration of marriages, demanded Mann who further urged for
the opening of ART centres at all district headquarters in Punjab
with a view to mitigating hardships of the affected people.

The Society's founder further urged the religious leaders and public
representatives to come forward to make Punjab a HIV-free state. He
revealed that apart from raising voice at various levels and forums,
the Society was currently engaged in providing free nutritious meals
and counseling to persons esp. the widows and the children living
with the deadly virus.

Curtailing the activities of quacks who offer guaranteed treatment
for the disease, participation of the common man in the drive against
the disease would go a long way in containing its spread in Punjab,
further opined Mann.

The Society activists who included Dr Manjit Singh Mann, Dr Harjinder
Singh, social activist Mehar Singh and De-addiction Centre chief
Kashmiri Lal also talked to some HIV positive persons of the district
on the occasion.

"We have seen that HIV positive people who are informed are better
equipped to decide if they will let people know about their HIV
status, and they are also better equipped to challenge discrimination
and stigmatisation," maintained Mann, adding that the society in
association with the district Red Cross Society would soon launch "an
AIDS-free campaign" in Nawanshahr.

http://www.punjabnewsline.com/content/view/10015/38/

After 25 years and billions of pounds, leading scientists are now
forced to ask this question

By Steve Connor and Chris Green
Thursday, 24 April 2008

Most scientists involved in Aids research believe that a vaccine
against HIV is further away than ever and some have admitted that
effective immunisation against the virus may never be possible,
according to an unprecedented poll conducted by The Independent.

A mood of deep pessimism has spread among the international community
of Aids scientists after the failure of a trial of a promising vaccine
at the end of last year. It just was the latest in a series of
setbacks in the 25-year struggle to develop an HIV vaccine.

The Independent's survey of more than 35 leading Aids scientists in
Britain and the United States found that just two were now more
optimistic about the prospects for an HIV vaccine than they were a
year ago; only four said they were more optimistic now than they were
five years ago.

Nearly two thirds believed that an HIV vaccine will not be developed
within the next 10 years and some of them said that it may take at
least 20 more years of research before a vaccine can be used to
protect people either from infection or the onset of Aids.

A substantial minority of the scientists admitted that an HIV vaccine
may never be developed, and even those who believe that one could
appear within the next 10 years added caveats saying that such a
vaccine would be unlikely to work as a truly effective prophylactic
against infection by the virus.

One of the major conclusions to emerge from the failed clinical trial
of the most promising prototype vaccine, manufactured by the drug
company Merck, was that an important animal model used for more than a
decade, testing HIV vaccines on monkeys before they are used on
humans, does not in fact work.

This has meant that prototype HIV vaccines which appear to work well
when tested on monkeys infected with an artificial virus do not work
when tested on human volunteers at risk of HIV – a finding that will
be exploited by anti-vivisectionist campaigners opposed to vaccine
experiments on primates.

Anthony Fauci, the director of the US National Institute of Allergy
and Infectious Diseases (NIAID), near Washington, told The Independent
that the animal model – which uses genetically engineered simian and
human immunodeficiency viruses in a combination, known as SHIV –
failed to predict what will happen when a prototype vaccine is moved
from laboratory monkeys to people. "We've learnt a few important
things [from the clinical trial]. We've learnt that one of the animal
models, the SHIV model, really doesn't predict very well at all," he
said.

"At least we now know that you can get a situation where it looks like
you are protecting against SHIV and you're not protecting at all in
the human model – that's important," he said.

The NIAID spends about $500m (£250m) on HIV vaccine research each year
and despite calls from some Aids pressure groups for funds to be
diverted to other forms of Aids prevention, Dr Fauci said this was not
the time to stop vaccine research. "I don't think you should say that
this is the point where we're going to give up on developing a
vaccine. I think you continue given that there are so many unanswered
questions to answer," he said. "There is an impression given by some
that if you do vaccine research you are neglecting other areas of
prevention. That's not the case. We should and we are doing them
simultaneously."

More than 80 per cent of the scientists who took part in our survey
agreed that it was now important to change the direction of HIV
vaccine research, given the failure of the Merck clinical trial, which
was cancelled when it emerged that the vaccine may have actually
increased the chances of people developing Aids.

Robert Gallo, a prominent Aids researcher in the US who is credited
with co-discovering the virus in the early 1980s, likened the
vaccine's failure to the Challenger disaster, which forced Nasa to
ground the space shuttle fleet for years.

At the end of last month, Dr Fauci convened a high-level summit of
leading HIV specialists at a hotel in Bethesda, Maryland, to discuss
the future direction of research. A group of 14 prominent Aids
specialists had already written to Dr Fauci suggesting that his
institute had "lost its way" in terms of an HIV vaccine.

He said that one outcome of the meeting was a refocusing of the
vaccine effort away from expensive clinical trials towards more
fundamental research to understand the basic biology of the virus and
its effects on the human immune system.

"We'll be turning the knob more towards answering some fundamental
questions rather than going into big clinical trials," Dr Fauci said.
"I'm certainly disappointed that we're not further ahead in the
development of a vaccine but I don't say that this year I'm more
discouraged than I was last year. I always knew from the beginning
that it would be a very difficult task given what we know about this
very elusive virus."

About 33 million people in the world are infected with HIV and some 26
million have died of Aids since the pandemic began.

The majority of scientists who responded to The Independent's survey
said that a vaccine would be the most effective way of preventing the
spread of the virus given the failure of many education programmes.

Winnie Sseruma, 46: 'For me, the key has been not to give up'
Ms Sseruma says she believes abandoning research for a vaccine would
mean a loss of hope for millions of people. "When I was diagnosed,
nearly 20 years ago, it was when the first drugs had come on the
market. A lot of people had said before then that there was no hope
and that all efforts should be put into prevention. But look where we
are now. We cannot lose hope; we need to invest in a vaccine."

She says this latest failure needs to be seen as the first hurdle, not
a signal to give up. "Yes, the scientists have not been very
successful in their quest for a vaccine, but you can learn a lot from
failures. Now they have realised they cannot use the normal routes
used to develope simpler vaccines."

Ms Sseruma lives in London, but was born in Uganda and says that the
current climate of pessimism for the vaccine is not dissimilar to the
initial doubts over the likelihood of treating HIV in Africa.

"I remember when treatment started being available in the West and
people were saying it would be impossible to send it to Africa. But
look what's happened. We should always do whatever is humanly possible
to fight Aids. It's been a long journey, but for me, the key has been
not to give up, and the scientists need to have the same attitude."

'Philippe B', 42: 'People are getting resistant to drugs'
"Philippe", who wishes to remain anonymous, discovered he was HIV
positive 11 years ago. The 42-year-old believes the search for the
vaccination should no longer be a priority, but that it should not
stop altogether.

"Unfortunately what's happening now is that people are getting more
resistant to drug treatment, and more money needs to be put into
finding more drugs for treatment," he said.

For people like Philippe, the fear of building an immunity to drugs
and running out of options is a real one. He believes that as long as
scientists are still pessimistic about the chances of successfully
finding a vaccine, money needs to be invested in continuing to fund
research into treatment.

"I've already become resistant to five combination treatments over the
last ten years, and if I was on the last one available I'd be very
afraid. HIV is not a death sentence in the way it once was, but we do
need to fund further research into the drugs that treat it."

Nevertheless, Philippe thinks it is not yet time to abandon all
research into a vaccine. "In my lifetime I don't think we'll have a
vaccine, but there's no reason we should believe it isn't possible,"
he said. "But we should now be spending more on other ways of dealing
with the disease."

http://www.independent.co.uk/news/science/is-it-time-to-give-up-the-search-for-a\
n-aids-vaccine-814737.html

http://www.tribuneindia.com/2008/20080425/punjab1.htm#6

Chandigarh, April 24
The All-India Motor Transport Congress, that
represents 40 lakh truckers and is an umbrella body of
various truck unions and goods transport companies
across the country, has tied up with the National Aids
Control Organisation (NACO) to check the spread of
AIDS among truck drivers and cleaners.

Charan Singh Lohara, president of the Congress, said
NACO had enough funds and knowledge to hold camps for
truck drivers and cleaners to make them aware with
regard to the preventive steps required to be taken in
this regard. “We have no funds and source material to
educate truck drivers and cleaners with regard to
AIDS. That is why we have tied up with NACO,” he said.

He said NACO officials had been invited to the two-day
conference that would be held under the banner of the
Congress in Kolkata on April 26 and 27 to discuss
various problems being faced by owners of trucks,
truck drivers and cleaners, besides other issues. “We
would chalk out a programme to hold camps at various
places in the country for truck drivers and cleaners,”
said Lohara.

Lohara said the issue of toll, diesel price, highway
robberies and services tax would be discussed in
detail at the conference.

Chairman of the parliamentary committee on transport
Sita Ram Yechuri will be chief guest at the congress.

Dear All,

Kindly see the below for the vacancy details.

Project officer - TB Project
Location         : Theni District, Tamilnadu
Last Date        : May 9th 2008


Detailed Information

Position vacant: Programme Executive - Health Advocacy in TB Project
DAC Trust , a network organization channeling overseas funds to NGOs, needs
Programme Executive for Health Advocacy Programmes at Theni District.

Job Description:

* Take responsibility for and support the health and advocacy work of
the partners - NGOs, women's federations and associations for positive
people, transgendered people, women in prostitution in Theni and other
districts.

* Coordinate public relations, undertake direct advocacy and ensure
working relationships with district health and other government departments.

* Oversee the management cycle (planning, monitoring, review and
evaluation) of existing programmes and follow up work plans and budgets based on
proposals.

* Coordinate liaison with existing donor agencies, ensure that their
reporting and other requirements are met.

* Ensure that capacity is built in the district and wider level teams,
identify and obtain high quality capacity building (inputs) and technical
advice.

* Coordinate evaluation and external review of the programmes, devise
and undertake operational research studies.

Qualification & Experience:

* Post Graduate in Health Management or related fields especially in
TB
* A minimum 5 years of experience in the TB field
* Excellent oral and communication skills
* (English & Tamil) (Tamil speaking candidates will be given
preference)

LOCATION:

Based at Theni District, Tamilnadu travel within and outside the district
required.

Only qualified candidates should reply. We will not respond to candidates who do
not demonstrate above attributes and who submit incomplete applications.

Interested candidates should submit their applications with a cover note
indicating their motivation to apply for the position applied for, current and
expected salary and 2 references to  <mailto:dactrust08@...>

This position is open to applicants of either sex. Preference will be given to
equally qualified women candidates.

Only short listed candidates would be contacted.

Last date is  -  May 9th  2008.

Thank you for your assistance and cooperation

Vanajaa
e-mail: <vanajaa@...>

Small blood banks to be closed

25 Apr 2008, 0354 hrs IST , Kounteya Sinha , TNN
NEW DELHI: Small blood banks, collecting less than 1,000 units of
blood annually from voluntary donors, will soon be shut down. They
will instead function as mere blood storage units, which will be
supplied with whole blood and blood components like plasma and
platelets by highly sophisticated "mother banks", coming up in each
of the four zones.

Each storage unit will then supply blood to hospitals and localities
around it to ensure that even the country's most backward areas don't
face shortage of the life-saving components.National Aids Control
Organisations (NACO) estimates that over 15% of the 2,433 government
and charitable blood banks will be converted.

The decision was finalized after the health ministry's Expenditure
Finance Committee (EFC) gave the go-ahead for NACO's proposal for
setting up four state-of-the-art blood separation centres last month.

These four "mother banks", which will be on par with the world's best
banks in France and Germany, will come up in the four metros. Each
bank, which will deploy nucleic acid testing technique that reduces
the risk of transfusing blood infected by HIV, Hepatitis B and
Hepatitis C by 34% to 92%, will collect one lakh units of blood per
year and separate them into components. The safe blood will then be
supplied to the storage centres.

Health minister A Ramadoss says the move to convert poor performing
blood banks into storage units will not only save manpower and money,
but also ensure high quality of blood transfusion services.

Dr Debashish Gupta, NACO's national programme officer for blood
safety, told TOI : "We will soon approach the Union Cabinet for final
approval to set up the four metro blood banks. We plan to start
constructing them within a year. These centres will provide blood and
its components to its respective regions."

According to Ramadoss, the use of blood components is alarmingly low
in India. He says that while in India, the ratio of use of blood
components to whole blood is 15:85, globally it is 90:10. He also
said that good laboratory practices and quality assessment measures
are questionable in most blood banks at present.

"At present, 80% of blood collected is given as whole blood. However,
the use of whole blood as a routine should be avoided. Use of blood
components will benefit more people and maximize use of a blood unit.
The four centres will have a research wing to study blood components.
They will also train doctors and technicians in blood transfusion
courses to ensure the country has a lot more trained manpower,"
Ramadoss said.

According to Gupta, the one lakh units collected in each centre will
be divided into four lakh units of various components like plasma,
platelet and factors 8 and 9.

"Presently, we are assessing the performance of our blood banks to
know which ones need to be converted into blood storage units. Once
decided, two doctors and three technicians will be posted there to
ensure smooth supply of blood to local requirements," Gupta said.

http://timesofindia.indiatimes.com/India/Small_blood_banks_to_be_close
d/articleshow/2980881.cms

Indians more prone to HIV-AIDS than others, says study

26 Apr 2008, 0307 hrs IST , Ashish Sinha , TNN
NEW DELHI: The biggest ever gene mapping exercise of the "people of
India" has shown that Indians are more vulnerable to HIV-AIDS than
many other population groups around the world. This is because a
protective gene marker against HIV-1 is virtually absent in India,
making the population more at risk.

The study also shows that the risk increases as one moves from north
to south India. It also says the Indian gene pool is quite varied and
the term or description "Indian" is hardly homogenous. It includes
several variations across population groups spread across the
country's land mass.

On the vulnerability to HIV-AIDS, the study says, "There is a high-to-
low gradient from north to south (India). These results are
consistent with the observations by Majumder and Dey in 2001, and the
antenatal clinical HIV prevalence survey (2005) that reports a high
frequency of HIV in south Indian populations."

The study, released by science and technology minister Kapil Sibal on
Friday, was carried out by more than 150 scientists and researchers
from six CSIR laboratories. A part of the genetic landscaping were
the Centre for Genomic Applications (Delhi) and a host of
anthropologists.

Gene study largest since Green Revolution

Perhaps the largest scientific endeavour since ICAR's Green
Revolution effort of 1970s, the mapping covered four main linguistic
families of Indians — Austro-Asiatic, Tibeto-Burman, Indo-European
and Dravidian. It also encompassed the mostly endogamous (marrying
within the larger social group) Indian population defined by distinct
religious communities, hierarchical castes and subcastes, and
isolated tribal groups.

The study, a part of the Indian Genome variation initiative, has
generated information on over 4,000 genetic markers from more than
1,000 biomedically important and pharmacogenetically relevant genes
in reference groups. The study reveals a high degree of genetic
differentiation among Indian ethnic groups and suggests
that "pooling" of endogamous populations without regard to "ethno-
linguistic factors" will result in false inferences.

"We note that the people of India are referred as 'Indian' in many
population genetic studies. The implication of such usage is that the
Indian population is genetically homogeneous, which, as the results
of our study indicate, is evidently not true. However, we have also
shown it is possible to identify large clusters of ethnic groups that
have substantial genetic homogeneity," it says.

The mapping is expected to help in constructing "specific drug
response/disease predisposition maps" to aid policy decision making
for drug dosage interventions and disease risk management, especially
for complex and infectious diseases.

ashish.sinha1@...

http://timesofindia.indiatimes.com/India/Indians_more_prone_to_HIV-
AIDS/articleshow/2984007.cms

Dear Friends,

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/8667

Mandatory testing goes with a number of positive and negative
outcomes. When we say mandatory, it is applicable to everybody at all
stages in life, in all walks of life, and will open up a whole number
of issues.Some questions are as follows--

1. Who will administer the test?
2. Who will disclose the information to the patient?
3. Will there be a registry?
5. Will there be a second test in a few months?
6. Will there be counseling available while disclosing the results?
7. Will the dependents of the tested-one be informed (either for
positive or negative outcomes)?
8. Where will the disclosure of the sero-positive status fall in the
legal panorama (will there be mandatory information disclosure to the
partner, patients of a sero-positive clinician...etc.)?
9. How will the aspect of social stigma be handled (micro-aspects as
well as macro-aspects)?
10. Have we studied the outcomes of mandatory testing in other
countries long enough before we apply it to the local population,
culture and social settings?
11. Is HIV and AIDS the only disease this applies to (there are a
whole number of other diseases that are comorbidities and some even
more potent as disease and health outcomes)?
12. When we have a lot of easily preventable infectious diseases that
are plaguing the population, why are we maily concentrating on HIV?

I was the first J&J Medical Inc. Infectious Diseases Post Doctoral
Fellow in Dentistry in the early 1990s and the same questions are
popping up now. It still has not been implemented in the place these
debates came up. Should we not wait and use a medical model of asking
the patient during a medical contact/visit rather than make it
mandatory?

I have now been working with the people in India in trying to set up
a higher level of Dental Safety including Occupational Safety for
Oral Health Professionals in India and get this question every time I
speak in India.

Best Wishes,

Raghunath Puttaiah BDS, MPH
Plano, Texas, USA
e-mail: <puttaiah.raghunath@...>

DR. BINAYAK SEN WINS PRESTIGIOUS INTERNATIONAL HUMAN RIGHTS AWARD

The Global Health Council today announced that Dr. Binayak Sen of
Chhattisgarh has won the *2008 Jonathan Mann Award for Global Health and Human
Rights.

The Global Health Council www.globalhealth.org is the world's largest
membership alliance of public health organizations and professionals working to
improve health and save lives among the poor.  The Jonathan Mann Award was
established by the Global Health Council in 1999 to honor Dr. Jonathan Mann and
to highlight the vital link between health and human rights.

Sponsored in 2007 by four organizations, Association François-Xavier
Bagnoud<http://www.fxb.org/>, Doctors of the World
<http://www.doctorsoftheworld.org/>, John Snow,Inc.<http://www.jsi.com/>and the
Global
Health Council <http://www.globalhealth.org/>, the Award is bestowed
annually to a leading practitioner in health and human rights.

Despite his untimely death in a 1998 plane crash, Jonathan Mann is
considered by many to be one of the most important figures in the 20th
century fight against global poverty, illness and social injustice.

As the first director of the World Health Organization's Special Program on AIDS
from 1986-1990, Dr. Mann pioneered the approach to AIDS that continues to shape
public health policy today. As Professor of Health and Human Rights at Harvard
University from 1990-1997, Dr. Mann began to articulate the ways in which the
health of individuals and populations reflects access to basic human rights,
using as his warrant his years as a public health practitioner and strategist
and as his text the Universal Declaration of HumanRights.

History will especially remember Dr. Mann for bringing to the world's attention
the basic notion that improved health cannot be achieved without basic human
rights, and that these rights are meaningless without adequate health.

A list of the 57 individuals worldwide who were nominated for the 2008 Mann
Award can be viewed at
http://www.globalhealth.org/conference/view_top.php3?id=850.

*Of note, and a matter of pride for India, nine of the 2008 nominees are
Indian:*  *Dr. Swami Hardas of Pune,  Mr. Surya Makaria of Hyderabad, Mr. Deelip
Mhaske of Mumbai,  Dr. Ugrasen Pandey of Firozabad,  Dr. Prameelamma Pedamali of
Srikalahasti,  Dr. Kamalesh Sarkar of Kolkata,  Dr. Mukesh Shukla of
Surendranagar, Dr. Diwakar Tejaswi of Patna, and Dr. Binayak Sen of Raipur*.

In reviewing these distinguished nominees, the international jury of public
health experts considered and evaluated several criteria including: practical
work in the field and in difficult circumstances; actual relevance to the
linkage of health with human rights; predominant activities in a developing
country and with marginalized people; evidence of serious and long-term
commitment; and potential for the Award to strengthen the nominee's work.

The Jonathan Mann Award along with three other awards (the Gates Award for
Global Health, the Best Practices in Global Health Award, and the Exellence in
Media Award for Global Health) will be presented to the winner at a formal
ceremony  during the annual meeting of the Global Health Council, which this
year takes place in Washington, DC, USA.

Dr Binayak Sen, alumnus of the Christian Medical College ,Vellore, has
devoted a lifetime to  the healthcare of the tribal population of
Chhattisgarh. Along with the legendary trade union leader Shankar Guha
Niyogi, he founded the Shaheed Hospital in the mining town of Dalli Rajhara, an
institution that  till today  continues the tradition of providing accessible
and rational  health care to the people.

For the last fifteen years, Dr Sen has worked in a remote tribal area treating 
those afflicted with chronic malnutrition, endemic malaria  and other infectious
diseases.

He has also worked on issues of food and livelihood security, and has been the
general Secretary of the State Unit of the Peoples' Union for Civil Liberties
(PUCL), as well as the National Vice Resident of the organization.

In this latter capacity he has been  a vociferous critic of  police excesses
carried out by an unaccountable state , and of the state sponsored vigilante
Salwa Judum movement in Chhattisgarh that has led to near civil war conditions
in large parts of southern Chhattisgarh.

Dr Sen has earlier received the Paul Harrison Award from his alma mater for his
contributions to 'redefining health care in a broken society', and the RR
Keithan Gold Medal from the Indian Academy of Social Sciences  for  .. 'a fresh
and radical interpretation of Gandhiji's core concerns..'

Unfortunately, as is well known within India,  Dr. Binayak Sen has been
incarcerated in the Raipur Central Jail in Chhattisgarh  on charges of being a
supporter of the banned Maoist party for almost one year, and is soon to stand
trial on charges under the Chhattisgarh Special Public Security Act.

In a letter to the President of India, the Prime Minister of India, and the
Chief Minister of Chhattisgarh, Dr. Nils Dulaire (president and chief executive
officer of the Global Health Council), has written:

Dr. Sen was selected for this honor by an international jury of public
health experts on the basis of his years of service in poor and tribal
communities in India, his effective leadership in establishing
self-sustaining health care services where none existed, and his unwavering
commitment to civil liberties and human rights.  His long history of selfless
service and this Award's recognition are commendations that we hope will be
celebrated by India's leaders and citizens.

*The irony of course is that Dr. Sen is now in his twelfth month of
imprisonment without trial in Raipur.  This is of deep concern to the global
health community.  Therefore those signing on to the statement attached here
felt it important to bring this matter to your attention and to kindly request
that you consider how means could be found to allow Dr. Sen to attend the
award's ceremony in Washington, DC, on May 29th, 2008.*

*We wish to be clear: it is not our intent to interfere with the judicial
process. We simply request that this doctor's good works and highly regarded
reputation as a man of science and service, and his international following,
serve as guarantee of his obligation to return to India to participate in a just
and fair judicial process after the awards ceremony, if his case is not resolved
sooner.*

*The world is watching this case. Some have expressed concern that it might
represent a dwindling respect for civil liberties in India. We believe, however,
that allowing Dr. Sen to attend the award's ceremony would send a strong signal
internationally that would help to restore faith that India and its states are
indeed committed to fairly addressing this and other cases related to civil
conflicts and civil liberties.  Dr. Binayak Sen's travel to the United States
for this purpose would pose no threat to the security of Chhattisgarh or the
integrity of the Indian judicial system. *

*Please consider finding the means to allow him to receive his award in person.
***

As the 2008 Mann Award winner, Dr. Binayak is the tenth individual and
the *first South Asian* to be thus honored by the Global Health Council. 
Previous winners include the following.  Dr. Bogaletch Gabre, a champion of
women's rights who is a pioneer in eradicating the practice of female genital
excision in Ethiopia (2007);  Dr. Juan Canales, who helped marginalized peasants
and indigenous communities in conflict-ridden areas of El Salvador and Mexico
gain their human right to health care by establishing community medicine and
public health programmes (2006);  Prof. Abdel Mohammad Gerais who advocated for
and established reproductive health services to those most
in need in Egypt (2005); Dr. Sima Sahar who led innovative programs in
health, education, construction, relief, and income generation to improve the
lives of women and girls in Afghanistan (2004);  Mr. Zackie Achmat and Dr. Frenk
Guni, who have worked to raise awareness and advocate for equit of people with
HIV/AIDS in South Africa and Zimbabwe (2003); Dr. Ruchama Marton and Mr. Salah
Haj Yehya,  associated with Physicians for Human Rights-Israel,  providing
volunteer health care in the occupied territories of the Wset Bank (2002); Dr.
Gao Yaojie, a gynaecologist involved in HIV/AIDS care and prevention work in
China (2002); Dr. Flora Brovina and Dr. Vjosa Dobruna who worked with refugees
in the Kosovo conflict and now with
women and children victims of war crimes, in Kosovo (2000); and Dr. Cynthia
Maung who committed her life to healing victims of human rights abuses in Burma
(1999).

An interesting parallel is that  one of the  Mann Award winners  in the year
2000 was also in prison at the time she was selected for the award. Dr. Flora
Brovina is the founder and director of the League of Albanian women in Kosovo,
and at the time the award was presented, Dr. Brovina was imprisoned in Serbia.
The world community dedicated to health and human rights celebrated her release
on November 1, 2000 after 18 months of imprisonment on charges that she
committed terrorist acts by helping refugees in the conflict in Kosovo.


Committee for the Release of Binayak Sen
C/O Janaarogya Andolana Karnataka,
359, Ist Main, Ist Block, Koramangala,
Bangalore - 560034.
Ph: 080-25531518

Community Health Cell
e-mail: <chc@...>

Drug abuse lands cops in deadly mess

22 Apr 2008, 0346 hrs IST , Yudhvir Rana & Shivani Mehra , TNN

AMRITSAR: Rampant drug abuse and unsafe sex is pricking hard the
Punjab Police, jeopardizing the lives of as many as 178 police
personnel in the district of Tarn Taran alone. What has only
compounded their case is the indifferent attitude of government,
which is yet to wake up to the ticking bomb within its ranks.

In startling revelations that should be enough to jolt the police
top brass, Sandeep Kakkar, the senior medical officer at Police
Hospital, Tarn Taran, told TOI on Monday that during a health check-
up doctors found 178 police personnel carrying the Hepatitis B, C
and HIV virus.

"In fact, 72 of the 178 who tested positive for these dreaded
diseases have been shortlisted as critical," he said, adding that
because expenditure involved in treating Hepatitis C was Rs 3.30
lakh per person, the only way these cops could possibly survive was
with government aid.

Every Hepatitis B or C patient has to be given Alpha B 2 Interferon
injection that costs around Rs 14,000 each and 24 such injections
have to be given to complete the course.

"None of the police personnel is in a position to spend this much
money and they are inching towards death due to lack of treatment,"
Kakkar said.

"Unclean syringes used by the drug addicts in the police department
coupled with unsafe sex practiced by some of them are the major
causes of the deadly viruses spreading."

IG, Border Range, Rajpal Meena admitted that drug addiction was a
major problem in Tarn Taran district and it was seriously affecting
the police force.

He said he had already taken up with the DGP the issue of treatment
of the infected cops.

Others too have stepped up efforts to have the suffering police
personnel treated urgently. AK Vermani, an advocate, informed that
sub-inspector Sucha Singh and head constable Balbir Singh have filed
a petition in court seeking immediate financial help for the 72
critical cops.

http://timesofindia.indiatimes.com/Cities/Punjab_Police_plagued_by_dr
ug_abuse/articleshow/2969652.cms

Position Purpose

I-TECH Country Director

The International Training and Education Center on HIV (I-TECH) is a global
network that supports the development of a skilled health work force and
well-organized national health delivery systems in order to provide effective
prevention, care, and treatment of infectious disease in the developing world. 
I-TECH envisions a world in which all people have access to high quality,
compassionate, and equitable health care.

I-TECH is a global health program of the University of Washington (UW) and the
University of California – San Francisco. Its administrative headquarters are
located at the UW in Seattle.  I-TECH operates programs and employs staff in
multiple countries in Africa, Asia, and the Caribbean Region.  I-TECH country
offices are led by a Country Director who serves as the lead I-TECH
representative for the country project.

The Country Director reports to the Director of Country Programs (DCP). The
position of Country Director requires an individual with demonstrated expertise
in public health program management and capacity development.  The position
requires effective and efficient communication with both domestic and
international staff, local Ministry of Health and other governmental bodies,
US-based funders and other implementing partners within and beyond the country
where the Country Director is placed.  The Country Director must provide
leadership in developing sustainable programs and in coping with rapid change of
direction to most effectively use available resources.  This requires the
ability to use sophisticated problem-solving skills and to successfully
interface and communicate within the organization, across the I-TECH network,
and externally.

The India Country Director has the additional responsibility to provide
leadership and oversight to the Indian Society called AroGyaan, which is the
Indian NGO formed to administer I-TECH activities in India.  This requires a
high degree of skill at managing a complex array of relationships between the
staff of AroGyaan, the Board of Directors of AroGyaan, USG and local partners in
country, and the University of Washington.


Responsibilities
Duties (Identify the percentage of time devoted to each activity.  List in
decreasing order of importance.)
It is the responsibility of all I-TECH staff to understand the organization’s
operating principles and apply the principles in their daily work

Strategic Leadership (40%):
•    Lead development of productive working relationships with national
government representatives, local and international non-government
organizations, and funders.  Advance effective communication, planning,
development and implementation of activities grounded in I-TECH’s recognized
leadership role in HIV/AIDS training.
•    Serve as the primary contact for I-TECH in-country administrative and
programmatic partners.  Represent I-TECH at stakeholder meetings to build
collaboration to advance I-TECH’s mission and vision.
•    Serve as the lead program and operational officer of the AroGyaan Society,
working in close collaboration with the Board of Directors and funding
organizations.
•    Provide technical assistance to national counterparts for high-level
planning with regard to health care worker capacity development, sustainable
approaches to training, and extension of health care services.  Participate in
relevant technical advisory groups with regard to these issues.
•    Lead regular strategic planning for I-TECH country project.  Mobilize
expertise and resources to address priorities in alignment with I-TECH country
strategic plan.
•    Promote I-TECH’s sustainability through new business development,
diversification of I-TECH funding sources, development of scope and/or depth
of-TECH’s technical expertise, extension of I-TECH’s mandate with respect to
training and health care worker capacity development.
•    Participate in I-TECH’s leadership team, and contribute to the
strengthening of I-TECH’s global network of projects.  Collaborate in
network-wide strategic planning.  Identify and promote avenues for network-wide
program exchange, sharing of best practices, and extension in innovative and
promising program areas.

Program Management & Administration (35%):
•    Oversee the implementation and use of I-TECH’s Program Standards and Global
Operations Manual at the country project level, with emphasis on in-country
capacity development to attain or surpass standards.
•    Assist in the development and implementation of network-wide program
management standards.
•    Provide leadership in the development, implementation and regular
monitoring of I-TECH country project activities.  Assume overall accountability
for attainment of I-TECH program goals, objectives and deliverables as detailed
in country operational plans (COPs) and country project workplans.
•    Develop and manage COPs, project workplans and budgets in collaboration
with I-TECH Country Project Deputy Director, country project team leads, and
Seattle-based Country Project Manager (CPM), as relevant.
•    Evaluate country project performance with respect to decentralization
milestones.  Identify technical assistance needs to I-TECH Headquarters to
support in-country capacity development, and report trends in capacity
development to the leadership team.
•    Oversee development, application and regular updating of written policies
and procedures for country office operations.  Assure concordance between
country project policies and procedures and I-TECH, UW, funder and national
government requirements and regulations.
•    Oversee all administrative, financial, logistical and security functions
within the country office.  Maintain overall responsibility for I-TECH
country-based project budget and staff.

Communication, Reporting, Monitoring & Evaluation (10%):
•    Communicate regularly and substantively with I-TECH headquarters on all
project activities.
•    Submit regular reports to funders and stakeholders as required.  Respond in
a timely manner to ad hoc reporting requests from CDC-Global AIDS Program,
USAID, and other partners.
•    Provide oversight to the development and implementation of I-TECH country
monitoring and evaluation plan.
•    Assure integration of Program Standards and Quality Improvement activities
throughout the country project.

Human Resources (15%):
•    Provide overall management of all in-country staff and consultants.
•    In collaboration with Director of Country Programs (DCP) identify optimal
organization chart and staffing pattern for country project.  Strategize
cost-effective, technically adequate approaches to staffing.
•    Collaborate with DCP, CPM, and UW colleagues to execute, implement, and
monitor a contract with a human resources services firm, as needed.  Ensure that
all contracts and employment packages are consistent with local practice and
labor law.
•    Hire, evaluate, discipline and/or discharge employees as necessary.  Review
requests for new and replacement positions, reclassifications, and salary
increases.
•    Provide regular feedback to direct reports, and support development of
supervision skills in team leads.
•    Collaborate with DCP to identify responsibility and authority delegation
matrix for I-TECH country project staff working under supervision of the Country
Director.  Contribute to effective mentoring of other team members to fulfill
their delegated roles.
•    Apply I-TECH principles throughout all aspects of staff oversight.  Embody
and engender those qualities that support an effective, efficient, inspired
workplace.  Support each team member in optimally contributing to the
achievement of overall programmatic goals and objectives.
•    Identify and lead initiative to promote staff professional development at
the individual and group levels.

Lead Responsibilities
The Country Director serves as the lead I-TECH representative for the country
project. The Country Director is responsible for partnership development,
oversight of country office operations, staffing and project implementation. The
Country Director supports I-TECH’s overall strategic direction toward a
decentralized and interdependent network of country projects.

Supervisory Responsibilities
Oversee the recruiting, hiring and evaluation of all locally hired employees and
consultants, either directly or with assistance from a locally contracted human
resources firm.

Position Complexities
Since I-TECH works in resource-challenged settings, the Director must provide
leadership in developing sustainable programs and in coping with rapid change of
direction to most effectively use available resources.  This requires the
ability to use sophisticated problem-solving skills and to successfully
interface and communicate within the organization and externally.

Position Dimensions and Impact to the University
UW is committed to developing its global health resources and extending its
international reach and influence, and the International Training and Education
Center on HIV (I-TECH) is a key UW partner in this vision.  I-TECH joined the
University’s new Department of Global Health in July 2007.  This department is
newly funded by the Bill and Melinda Gates Foundation and is symbolic of the
rapid growth of Seattle as an epicenter for international health.  The
Department’s goals are to: to meet the needs of our students, trainees, and
faculty and to prepare them for global health work; create an organizational
structure to address teaching (education, training, and mentoring), research,
and service (technical assistance and development); and help bring together the
many largely unconnected global health-related activities at the UW to create
complementary or synergistic interdisciplinary programs that address the causes
of and solutions for global health disparities.  The
  Department’s values include: respect for disadvantaged individuals and
populations; justice and equity in global health; diversity and breadth of
experience of faculty and students; sustainable partnerships; and
action-oriented learning, research, and service.

Position Qualifications
Required – Minimum Education (e.g., BA, MS, PhD; include the field of study)
Advanced degree in Public Health, Health Administration or related field.

Required – Minimum Work Experience (number of years and type of experience)
•    Five years of related work experience, with a leadership role in complex,
multi-faceted public health programs
•    At least three years of experience in a supervisory role, including
supervision of managers, technical experts and support staff
•    Fluency in English (reading, writing, speaking)
•    Knowledge of issues faced by developing countries with high HIV prevalence
•    Knowledge of program management, monitoring and evaluation methods
•    Experience with budget development and management, and monitoring of fiscal
systems
•    Working knowledge of US government and other grants and contracts systems,
to advance project progress and comply with funder directives
•    Demonstrated ability to bring together diverse professionals into a
functioning, effective work team
•    Demonstrated ability to facilitate effective collaboration with diverse
partners
•    Excellent written and verbal communication skills
•    Demonstrated ability to interact with persons from a variety of
professional disciplines and from different levels of society in a tactful,
diplomatic, and culturally-appropriate manner
•    Demonstrated ability to work independently, with balance between strategic
leadership and attention to detail

Desired – Education, Work Experience
•    Experience in human and organizational capacity development
•    Experience working within Non-profit/NGO structures, and in particular
working with Boards of Directors
•    Experience living and/or working in limited-resource settings
•    Experience with training program development, curriculum development, and
training facilitation
•    Computer skills including MS Word, PowerPoint, Excel and Access

Working Environmental Conditions
This position is 1.0 FTE, based in Chennai, India.  The CD job requires a
two-year commitment, with possibility of extension pending funding.  The CD must
be available and willing to travel within India and internationally up to 15%
and must be prepared to follow the UW and US government recommended precautions
and prophylaxis for disease.  Several times per month, the CD job requires
participation in conference calls during the early morning and late evening to
accommodate the time difference between the country office and HQ.

HOW TO APPLY

Interested parties should submit cover letter and CV directly to:
infoitechindia@...
or

mail them to:
The Senior Office Manager
International Training & Education Center on HIV (I-TECH India)
Government Hospital of Thoracic Medicine
Training Center
Tambaram Sanatorium
Chennai 600 047

Tel./Fax No. +91-44-22414200

Only those meeting the required qualifications will be contacted.

LAST DATE FOR RECEIPT OF COVER LETTER & CVS:
21ST MAY 2008

Jasmine B Rajan
E-mail: <jasminebrajan@...>

Dear FORUM,

We as HMAP are working in Lahore, Kasur and diffrent cities of Punjab Pakistan.

We are very sorry to know the attitude of the people towered sex workers.
Although,  We could not particepate in your protest against this bad very bad
and shocking activity of that crowd, but we are with you with warm wishes and
pray for your sucsess.

Its realy bad. We also want to say that human right Associations must have to
particepate in Kalkota.

Regards

Dr. Altaf H. Tariq
Chairman
Homoeopathic Medical Association of Pakistan
27 Elahi Bukhsh Park, Shadbagh Lahore 54900
Pakistan
e-mail: <ahtariq@...>

Dear all,

The incident is indeed shameful & deplorable.

We appreciate the action taken by DMSC which should yield positive results.

However we may also need to keep in mind the local factors which has
resulted in the precipitation of such an incident. We are active in the
neighbouring district of Muzaffarpur and have noted that these incidents are
usually sponsored acts with specific outcomes in mind.

The affected area is dominated by a marginalised community (religious as well as
professional) and the land owned by few land sharks and well to do businessmen,
who construct temporary shelters with bamboo and mud and lease them out for
astronomical sums to the CSWs.

Their illegal business has also been affected by this incident in addition to
the local daily mela related transactions.

It may be possible that there are many vested concerns and conflict of interests
in the region.

While talking to the state administration and district security forces to ensure
action, it may also help if the affected community was helped to get back on
their feet through immediate creation of a local representative body and a
facilitative watchdog.

The local DM and SP is sensitive to the issue and are doing everything to
ameliorate the situation. SDO has been entrusted with the safety and
rehabilitation of those affected.

While raising our voices for justice maybe as activists we should also take this
opportunity to highlight the issue at proper quarters and ensure that the
situation is handled in a sensitive manner by the local Govt.

We should advocate for extension of long term positive rehabilitation oriented
benefits which has eluded the affected community for long.

District Welfare Office can be a source for some interaction in this regard in
addition to the URDA & DRDA. They are active in the district and can be
harnessed for support.

This will ensure a lasting solution for those in need.

Best regards,

Alok


Dr. Alok Lodh,

National Coordinator Public Health, MAA, Chief Operations & Zonal Office (East),
Sinha House, Bankers Colony, Kayastha tola, PO: MIC
Bela, Sherpur, Muzaffarpur, Bihar, India, Pin: 842005
Per. email: draloklodh@..., Mobile: 0-9931404833

Minor girls fall prey to HIV+ rapist

20 Apr 2008, 0342 hrs IST , Ajitha Karthikeyan , TNN

CHENNAI: Parents of two minor girls from Kottangulam village near
Srivilliputhur in Virudhunagar district are in shock. The district
police on Saturday arrested a 38-year-old HIV positive man, a
relative of one of the girls, based on a complaint that he had raped
the two girls and passed on the deadly virus to them.

Police arrested Ayyappan, a mason, a day after the parents of the
girls filed a complaint, and booked him under IPC 376 (rape) and 506
(1) (intimidation), district superintendent of police T Senthil Kumar  told The
Times of India over phone from Virudhunagar.

Even two months ago, the district staff of the Tamil Nadu State AIDS
Control Society (TANSACS) came to know that the two girls had been
infected with HIV and suspected that Ayyappan could be the
culprit. "But we could not do anything without the parents
cooperating with us," said a TANSACS staff, who did not want to be
named.

Police said that Ayyappan, whose wife died a year ago after setting
herself on fire, was a neighbour and relative of the unsuspecting
girls, aged 12 and 15. Villagers say that the woman had killed
herself after she came to know that her husband was HIV positive.

The victims, both school dropouts, were friends of Ayyappan's
daughter and they used to frequent one another's house. The accused
must have raped the girls over a period of time until a year ago,
police said. When the girls began to fall sick frequently, doctors at
the government hospital took tests for HIV and both confirmed
positive for HIV. Though the test was taken six months ago, the
shattered parents kept it under wraps fearing social stigma and also
harassment from Ayyappan, who was one of the girls' uncle.

They chose to lodge a complaint only on Friday night after much
persuasion from a TANSACS official who was sent from Chennai to make
enquiries about the allegation.

Ayyappan had apparently claimed that the girls were willing partners
in the sexual act. "We have to verify this with the girls. Anyway it
still amounts to rape as the victims are minors," said Senthil Kumar.

Ayyappan also claimed to have known about his HIV status only two
days ago when he took a test in the hospital.

Taking a serious note of the incident, Tamil Nadu State AIDS Control
Society (TANSACS) project director Supriya Sahu sent a team of
officials to Srivilliputur for investigation and asked the district
collector and the SP to take action.

http://timesofindia.indiatimes.com/Cities/HIV_man_rapes_minors_in_TN/articleshow\
/2964985.cms

Dear Forum,

Do all agree that HIV screening is the best method of HIV prevention, and not
the targeted interventions, not the effort to bring in attitudenal changes, and
not the attempt to promote condom usage?

Prevention has two stages - one where inteventions are instituted where chances
of exposure itself is reduced, ultimately eliminated, and two instituting
prventive startegies by universal testing and starting drug therapy wherever
indicated.

In the first ultimate aim is to raech a zero level of exposure, whereas in the
second it gets accepted that exposure has taken palce, and now it is a question
of preventing the clinical manifestation, and prevent further contact exposure.
It may be realised that like small pox HIV virus survives only in living
tissues, and therefore if all exposures are prevented we may expect to win over
the disease.

Moreover, in a country like India we have not yet perfected the art and sceince
of properly treating and disposing our biomedical waste, and there is any magic
wand which can bring about drastic change in this matter.

I have been engaged in educational, and awareness programs on biomedical waste
management for the last 10 years, and let me  assure you that we are still far
away from acheiving a satisfactory universal application of biomedical waste
management strategies in hospitals, nursing homes, dental centers, diagnostic
labs, veternary hospitals, outpatient departments, rural healthcare facilities
etc.

Same is true for HIV testing centers. If that be so universal testing for HIV,
either for the whole population or for a tergeted section of population, such as
expectant mothers will be frought with dangers of increasing chances of exposure
to the virus in the injection waste, when used needles and syringes are not 100
% captured and disinfected thoroughly, and when we very well know that in India
more than 50 % of used syringes are brought back as new without disinfection.
Therefore there are many other factors than what meets the eye.

However, I do agree that all should work towards reducing feeling of stigma.

Lalji K Verma
President, ISHWM
www.medwasteind.org

Air Mshl Lalji K verma AVSM (Retd)
MBBS, M Sc (E&E), psc, FRSA
253, AFNO Enclave, Plot-11, Sector-7, DWARKA, New Delhi 110075
Tele +91-11-9312626462
e-mail: laljeeverma@...

HIV testing kits planned for hospitals

Staff Reporter

GUNTUR: Buoyed by the response from private medical practitioners to
the `Be Bold' campaign initiated last year, Andhra Pradesh State Aids
Control Society (APSACS) will soon supply HIV testing kits,
Nevirapine drug and free delivery kits, to selected hospitals in the
State, in which an average of 50 deliveries take place.

"The APSACS has completed the exercise of district-wise mapping of
the hospitals. The idea is to encourage hospitals perform more
deliveries and give their assent to deliveries of HIV infected
mothers too," Prevention of Parent to Child Transmission of HIV and
Anti Retro Viral Therapy Consultant Bindu said on Monday.

She was here to take part in the three-day counselling on PPCTC for
staff nurses working in Community Health Clinics and ART centres
conducted by the Department of Obstetrics and Gynaecology on
Government General Hospital premises.

The programme would address issues of stigma and discrimination and
was aimed at counselling nursing professionals working in pre and
anti-natal wards.

Focus would be on hygiene and universal safety precautions while
handling the deliveries, she said.

The APSACS is also toying with the idea of upgrading of PPCTC centres
by setting up facilities to transport the blood samples to the
nearest ART centre within a day and give the report of CD4 count to
the patient within a day.

The project would be implemented in Guntur district on a pilot basis
and extended to entire State, she added.

The Government was also mulling over the idea of setting up five more
ART centres in Machilipatnam, Chittoor and Tenali in Guntur district
etc.

Of the 46,304 deliveries which took place in the district in 2007,
645 were tested positive with the Ante Natal prevalence rate touching
1.39 per cent, which is slightly higher than the prevalence rate of
the State at 0.88 per cent. Head of Department of Obstetrics and
Gynecology Vasanth Kumar and others were present.

http://www.thehindu.com/2008/04/22/stories/2008042250670200.htm