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Background: The burden of the COVID-19 pandemic on healthcare systems worldwide has been compromising the progress made in the fight against HIV. This paper aims to determine how the COVID-19 pandemic has impacted HIV comprehensive care service delivery globally as well as to consolidate the evidence and recommendations that may be useful in averting future crisis. Methods: This review adheres to PRISMA guidelines. PubMed, DOAJ, Science Direct and other sources like Google Scholar and citations from included studies were searched methodically to locate studies evaluating the effects of COVID on services for HIV care. The NIH and JBI quality assessment tools were used for the quality assessment of individual studies. Results: In the present review 31 eligible studies were included and the impact on HIV care cascade were summarised under six themes: Lab services, Treatment and allied services, Counselling services, Outreach services, Psycho-social impact and Implementation of sustainable strategies. The studies also presented many innovative alternatives which were lucidly highlighted in the present article. Conclusion: Current evidence depicts multiple factors are responsible for the interruption of HIV care service delivery during the pandemic, especially in low resources settings. The prospective, alternative solutions that have been used to circumvent the threat have also been addressed in this review, in addition to the negative aspects that have been observed. Transition with new innovative, sustainable care paradigms may prove to be the building blocks in removing HIV-AIDS as a public health threat. Registration: Open Science Framework (DOI: 10.17605/OSF.IO/74GHM). [ABSTRACT FROM AUTHOR]

Introduction: In this paper, we analyzed the study of a mathematical model of non-linear differential equation on the effect of HIV/AIDS disease among unaware HIV/AIDS-infected population. Material and methods: Population was divided into four categories, including HIV-negative individuals, unaware HIV-positive cases, aware HIV-positive, and AIDS patients. The model was investigated numerically and analytically using fourth-order Runge-Kutta approach and homotopy perturbation method (HPM). Results: We have discussed the parameter variation graphically. Conclusions: Determining the dynamics of HIV prevalence and investigating the effect of each parameter on the governing equation can be simple with analytical solution. [ABSTRACT FROM AUTHOR]

Purpose: Prisoners are at a higher risk of HIV infection compared to the general population. The purpose of this study is to estimate the prevalence of HIV and related risk behaviours among inmates of the Central Prisons in four states of North India. Design/methodology/approach: The HIV sentinel surveillance was conducted in seven Central Prisons in four states of North India from February to April 2019. Four hundred inmates were included from each prison. The interviews were conducted at the Integrated Counselling and Testing Centre located within the prison premises. The Ethics Committee of the National AIDS Control Organization, New Delhi, granted ethical approval before the start of the surveillance. Findings: Overall, 2,721 inmates were enrolled in this study. The mean (SD) age was 38.9 (13.9) years. One-third of prison inmates had comprehensive knowledge about HIV/AIDS. The proportion of convict (54%) and undertrial (46%) inmates was almost equal. The overall prevalence of HIV infection among inmates was 0.96% (95% CI 0.65–1.40). The odds of being HIV positive were significantly higher in never married inmates, undertrials, inmates who were in the prison for more than three months to one year, inmates incarcerated for multiple times, inmates with history of injecting drug use and inmates with history of intercourse with a commercial sex worker. Originality/value: The findings from the very first HIV sentinel surveillance in central prisons in North India have been presented in this paper. This has huge implications for future policy decisions. [ABSTRACT FROM AUTHOR]

Background: The Joint United Nations Programme on AIDS (UNAIDS) has emphasized on the incidence-prevalence ratio (IPR) and incidence-mortality ratio (IMR) to measure the progress in HIV epidemic control. In this paper, we describe the status of epidemic control in India and in various states in terms of UNAIDS's recommended metrices. Method: The National AIDS Control Programme (NACP) of India spearheads work on mathematical modelling to estimate HIV burden based on periodically conducted sentinel surveillance for providing guidance to program implementation and policymaking. Using the results of the latest round of HIV Estimations in 2019, IPR and IMR were calculated. Results: National level IPR was 0.029 [0.022–0.037] in 2019 and ranged from 0.01 to 0.15 in various States and Union Territories (UTs). Corresponding Incidence-Mortality Ratio was at 0.881 [0.754–1.014] nationally and ranged between 0.20 and 12.90 across the States/UTs. Conclusions: Based on UNAIDS recommended indicators for HIV epidemic control, namely IPR and IMR; national AIDS response in India appears on track. However, the program success is not uniform and significant heterogeneity as well as expanding epidemic was observed at the level of States or UTs. Reinforcing States/UTs specific and focused HIV prevention, testing and treatment initiatives may help in the attainment of 2030 Sustainable Development Goals of ending AIDS as a public health threat by 2030. [ABSTRACT FROM AUTHOR]

The Research Agenda generated by the 7th World Workshop on Oral Health and Disease in AIDS (WW7) is delivered in this paper. Panels of international experts presided over nine workshops that constituted the conference held in November 2014 in Hyderabad, India. The main goal of the Workshop was to bring together clinician and scientists interested in the subject to debate with world-wide perspectives current issues related to the oral manifestations in HIV/AIDS. The workshops were structured around three themes; basic science, clinical/translational science and social science and were attended by 135 participants from 31 countries. The research questions debated at the workshops are presented in nine consensus papers published in this issue and are summarised in this paper along with an outline of the identified research needs in the field. [ABSTRACT FROM AUTHOR]

In the epidemic era of HIV/AIDS, sexually transmitted infections (STIs) are one the most common identifiable health challenges globally. The paper attempts to take account of and understand the incidence of sexually transmitted infections (and HIV/AIDS) in Arunachal Pradesh, the largest state in North East, India. The study reveals high STI cases in the state; and the districts recorded the high cases of STIs includes West Kameng (781 cases), East Siang (7113) and Changlang (642 cases) in 2012-13 and Papum Pare (683 cases) and West Kameng (593 cases) in 2013-14. All this reflects the deficit of knowledge for protecting and preventing oneself from these preventable STI cases. The study underscores the importance of promoting knowledge and awareness of STIs and particularly of HIV/AIDS amongst the youth of the state. [ABSTRACT FROM AUTHOR]

This paper builds upon the theoretical framework advanced by the growing literature on vulnerability. The paper explores how vulnerability to HIV/AIDS applies to young women living in the slum areas of New Delhi and Hyderabad. This circumscription of scope is based on a study on AIDS awareness levels in these two Indian cities conducted during summer of 2006. Using a qualitative approach, the paper offers insightful narratives from a sample of 26 women about their cultural and socio-economic circumstances with reference to HIV/AIDS. The excerpts from these women give a poignant view of their precarious circumstances with reference to lack of female autonomy, economic vulnerability, low AIDS awareness, and lack of access to pertinent information about HIV. The female youth were highly susceptible to the double bind of age and gender based hierarchies present in the patriarchal Indian social system. [ABSTRACT FROM AUTHOR]

‘Gender paradox’ in Kerala refers to the ‘contradiction’ whereby women’s high showing in socio-demographic indicators of development exists simultaneously with their low public participation and the increasing incidence of violence upon them. Given that ‘gender paradox’ has become the overwhelming context for imagining women in Kerala today, this paper seeks to examine its anatomy. The paper argues that there are two divergent descriptions of contemporary Kerala which circulate with comparable energy – Kerala as utopia and as dystopia. Theorisations of paradox bring these two worlds together, but without having sufficiently reckoned with their internal dynamics. Consequently, the paper explores the interiors of these worlds. It examines utopia through two discrete, yet intersecting social discourses – (a) the Kerala model of development and (b) tourism. It then proceeds to examine dystopia through the discourses around AIDS and sexual violence, which tend to be configured in analogous ways. The paper focuses on how women are gendered in these two worlds and concludes that they evoke two very different kinds of women. In the light of these explorations the paper goes on to lay out some of the implications and inadequacies of using gender paradox as the condition for speaking about women in Kerala. It argues that, instead of serving as a site for radical critique and productive feminist politics, gender paradox often become an occasion for conservative re-telling. [ABSTRACT FROM AUTHOR]

The public works program (PWP), the Mahatma Gandhi National Rural Employment Guarantee Act (MNREGA) in India, opened a new chapter in rural governance, signifying transformative potential for enhancing economic and social security. Despite the aim of this social protection scheme to enhance the "livelihood security of the household", provide employment to landless labourers, and encourage sustainable development, young men still opt to be migrant labourers in Bombay, many of whom become infected with AIDS and subsequently die. Often economic returns outweigh social risks and the new channels of disempowerment it reopens for women and children who are dependent on the income of these migrant men. We draw on ethnographic research conducted in Udaisarai (Gram Panchayat), Bhitaura block in Fatehpur District (Uttar Pradesh), to uncover rural-to-urban migration to Bombay, for better employment opportunities, and AIDS as one of the fallouts of the poor implementation of MNREGA. These pressing concerns need to be critically evaluated. [ABSTRACT FROM AUTHOR]

There is paucity of evidence on cost of antiretroviral therapy (ART) delivered through the public sector in India. Moreover, the Government of India is considering changing the criteria for introduction of ART to HIV patients, which is likely to have significant economic implications. In this paper, we assess the health system cost of ART services at two levels of health care delivery. Bottom-up costing was used to collect data on capital and recurrent resources consumed over a period of one year (April 2014–March 2015). Capital costs were annualized and shared costs apportioned to calculate annual and unit costs of providing ART care. Sensitivity analysis was undertaken to measure the extent of uncertainty in input prices. The annual per capita cost of ART therapy was INR 48,975 (USD738) in the Centre of Excellence (COE) and INR 24,954 (USD376) in the ART centre. Drugs contributed around 70% and 65% of total annual cost, followed by human resource (19% each) and capital cost (7%; 12%) in COE and ART centres, respectively. These provide a comprehensive assessment of the cost of ART care in India. The study estimates could be used for planning of services, as well as undertaking further cost-effectiveness studies. [ABSTRACT FROM AUTHOR]

Introduction: Role of vaginal sex in heterosexual transmission of HIV has been investigated but that of heterosexual anal sex (HAS) is not fully understood. This paper examines practice of HAS among Female Sex Workers (FSWs) and its correlates in India where the HIV epidemic is being primarily driven by core groups like FSWs. Methods: Data for this paper are drawn from Round I survey of 9667 FSWs in the Integrated Biological and Behavioral Assessment (IBBA) from 23 districts of 4 high HIV prevalent states of India. Bivariate and multivariate analysis identified factors associated with HAS. Results: Ever having anal sex was reported by 11.9% FSWs (95% CI: 11.3%–12.6%). Typology (AOR 2.20, 95% CI 1.64–2.95) and literacy (AOR 1.28, 95% CI 1.10–1.49) were positively associated with practice of HAS. Longer duration in sex trade (AOR 1.69, 95% CI 1.44–1.99), entertaining larger number of clients the previous week (AOR 1.78, 95% CI 1.47–2.15), alcohol consumption (AOR 1.21, 95% CI 1.03–1.42) and inability to negotiate condom use (AOR 1.53, 95% CI 1.28–1.83) were also correlated with HAS. Self-risk perception for HIV (AOR 1.46, 95% CI 1.25–1.71) did not impede HAS. Although symptoms of sexually transmitted infections (STIs) in the last 12 months were associated with anal sex (AOR 1.39, 95% CI 1.13–1.72) there was no significant association between laboratory confirmed HIV and other STIs with HAS. Conclusion: Practice of HAS by FSWs might significantly contribute to HIV transmission in India. This study also shows that despite self-risk perception for HIV, even literate FSWs with longer duration in sex work report HAS. General messages on condom use may not influence safe HAS. FSWs need to be targeted with specific messages on HIV transmission during anal sex. Women controlled prevention methods, such as rectal microbicides and vaginal microbicides are needed. [ABSTRACT FROM AUTHOR]

Increasing emphasis is being placed on the need for 'structural interventions' (SIs) in HIV prevention internationally. There is great variation in how the concept of SI is defined and operationalised, however, and this has potentially problematic implications for their likely success. In this paper, we clarify and elucidate what constitutes a SI with particular reference to the structured distribution of power and to the role of communities. We summarise the background to the growing emphasis being placed on the concept of SIs in HIV prevention policy, and present ethnographic case-study material from a sex worker's HIV project in Kolkata, India, to illustrate the nature of HIV vulnerability and its implications for the design and targeting of successful SIs. The paper draws attention to the dual importance of (1) attending to local complexities in the micro and macro-level structures that produce vulnerability; and (2) clarifying the meaning and role of communities within SIs. [ABSTRACT FROM AUTHOR]

This paper examines technical practices, such as epidemiological modeling, used to produce HIVprevalence estimates within India's national policy establishment. These technical practices are a useful site within which to investigate the shifting politics between India's national government and international agencies such as the World Bank and UNAIDS. The paper argues that international actors, and the technical practices they purvey, carry a 'foreknowledge' about the epidemic. This foreknowledge provides a pre-existing template of an AIDS epidemic; it helps the government imagine what an AIDS epidemic looks like, anticipate patterns of risk, and plan public health interventions. However, pre-packaged foreknowledge leaves relatively little room for surprises, and sits alongside a selective silencing of local experiences and public health history. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to describe the use of ICT to disseminate preventive health care information to combat the AIDS epidemic in India. The role of information professionals in various libraries and information centres and the challenges they are facing to increase HIV/AIDS awareness are discussed. Finally, recommendations are given and the conclusion is drawn that libraries and information professionals must develop AIDS literacy programmes to cater to the growing health information needs of the community. Design/methodology/approach -- Literature search, web site information and personal interaction with the key persons associated with various HIV/AIDS awareness projects. Findings -- lack of knowledge about AIDS, its modes of transmission and ways to avoid infection, are major challenges in India. Staff in ICT-based library and information centres can make a high impact on the local community by developing community-based AIDS literacy programmes and hopefully save the society from an AIDS epidemic. There is a perceived need for providing health information services through public libraries to the illiterate rural population who are increasingly making themselves vulnerable to HIV/AIDS. However, awareness of e-channels is low, especially in rural India; one solution is to increase take-up and run AIDS awareness campaigns through electronic media. Originality/value -- A summary is provided of ICT-based projects and initiatives by libraries and other agencies to disseminate AIDS information. Few multi-type consortia have been formed in the USA and UK to develop AIDS databases and e-learning modules are listed. These can be used as examples by Indian libraries with limited resources wishing to enhance community awareness through ICT. The concerted efforts amongst stakeholders are emphasized with the objectives of enhancing information professionals' skill in the AIDS information dissemination process. [ABSTRACT FROM AUTHOR]

Three-hundred and eighty-five social work students enrolled in 11 colleges in India were surveyed. Overall, the students demonstrated a moderate degree of knowledge about HIV/AIDS. However, they were generally unconcerned about the contagion. Three-fourths admitted to their lack of competence to deal with HIV+ patients. Regression analyses identified the positive effect of AIDS knowledge in combination with variables ‘actual contact with AIDS patients’ and ‘sense of competence’ on attitude toward PHWA. The paper discusses a curriculum strategy aimed at gender sensitive content and recommends behavior change as the best approach to reverse the tide of the contagion. [ABSTRACT FROM AUTHOR]

This paper sets out to describe the characteristics of HIV/AIDS in India, especially in the western Indian state of Maharashtra, and how Australian technology is being transferred to India to assist with the control of this epidemic. Specifically, the paper looks at Australian involvement in the Ansell-Raymonds joint venture, which manufactures the Kamasutra condom. To begin with, however, the problem of HIV/AIDS and its control in India is set into a broader cultural framework that looks at why HIV/AIDS in India has been so prolific and spread so quickly. By what means might the spread of HIV/Aids be controlled? The article questions the adequacy of the responses to HIV/AIDS in India, given the failure to identify men having sex with men as a major source of risky behaviour. We assess the contribution that the Kamasutra condom might make in the light of this broader discussion about the culture of sex and sexually transmitted diseases in India. Clearly the response of the private and public sectors in India have been far from adequate; perhaps as many as four million people in India now have HIV infection. Given the absence of any cure, and the lack of cheap medicines to delay the onset of death, the majority of HIV-infected people in India are likely to die. The HIV/AIDS epidemic is emerging as possibly India's greatest public-policy failure since independence. [ABSTRACT FROM AUTHOR]

This paper provides HIV estimation methodology used in India and key HIV estimates for 2010-2011. We used a modified version of the Spectrum tool that included an Estimation and Projection Package as part of its AIDS Impact Module. Inputs related to population size, age-specific pattern of fertility, gender-ratio at birth, age and gender-specific pattern of mortality, and volume and age-gender distribution of net migration were derived from census records, the Sample Registration System and large-scale demographic health surveys. Epidemiological and programmatic data were derived from HIV sentinel surveillance, large-scale epidemiological surveys and the programme management information system. Estimated adult HIV prevalence retained a declining trend in India, following its peak in 2002 at a level of 0.41% (within bounds 0.35-0.47%). By 2010 and 2011, it levelled at estimates of 0.28% (0.24-0.34%) and 0.27% (0.22-0.33%), respectively. The estimated number of people living with HIV (PLHIV) reduced by 8% between 2007 and 2011. While children accounted for approximately 6.3% of total HIV infections in 2007, this proportion increased to about 7% in 2011. With changing priorities and epidemic patterns, the programme has to customise its strategies to effectively address the emerging vulnerabilities and adapt them to suit the requirements of different geographical regions. [ABSTRACT FROM AUTHOR]

This paper is based on the last public lecture given by Dr Solomon at the 7th World Workshop on Oral Health & Disease in HIV/AIDS, held in Hyderabad, India, in November 2014. It examines the social impact of HIV in India and the founding of the Y.R. Gaitonde Center for AIDS Research and Education (YRG CARE) clinic in Chennai, India, by Dr Suniti Solomon and her colleagues. This is a story of prejudice and ignorance throughout the various social levels in India. Reports of India's first AIDS case surfaced in 1986, when female sex workers were found to be HIV positive. The first voluntary counseling and testing center, part of a sexually transmitted diseases (STD) clinic, was set up to increase awareness about the epidemic. To address the rapid spread of HIV infection in Tamil Nadu and the existing stigma in society and hospitals, Dr Solomon established YRG CARE in 1993. She recognized that fear and panic about HIV led to widespread social prejudice against HIV-positive patients, even within hospitals. By the end of 2014, over 34 000 patients had accessed these services and 20 000 HIV+ patients had been registered, nearly 40% of whom were females. The team embarked on a statewide awareness program on HIV and sexuality, covering over two hundred schools and colleges educating them about prevention strategies and combating the social stigma attached. The grass-root work of YRG CARE in the management of HIV infections revealed a widespread prejudice, due largely to the lack of awareness about the subject. It is estimated that even in 2015, as little as 40% of HIV-infected people are formally diagnosed and have access to care. In a country as socially and culturally diverse as India, there is much more to be carried out to build on the pioneering work of Dr Solomon. [ABSTRACT FROM AUTHOR]

Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) are among the greatest public health challenges around the globe. India ranks the third largest HIV epidemic in the world. People Living With HIV (PLWH) are highly susceptible to life threatening conditions as HIV destroys the body's immune system. Despite anti-retroviral treatments, tackling HIV and AIDS has been an uphill task for decades with all the countries contributing their best to decrease the incidence and mortality rate. But this has been difficult as there are problems in plenty across the globe. Loss of life, economic burden, psychological effects, stigma, discrimination are the perennial problems of HIV and AIDS. Awareness about HIV/AIDS and factors influencing the disease progression is the key to break this cycle. One of the important factors influencing the disease outcome is immune status of an individual. The immune system is highly influenced by nutrition which is an integral part in managing HIV. Nutrition has always contributed to the robust functioning of the immune system of an individual. PLWH almost always have malnutrition which, if not corrected, influences the outcome of HIV infection drastically. With people across the globe showing malnutrition, either under or excess, the immune system functioning is impaired, particularly so in PLWH. Unfortunately, nutrition has been ignored or sidelined in managing HIV/AIDs. This review gives an overview of the interrelation of nutrition and immune system and how these influence the outcomes in PLWH. [ABSTRACT FROM AUTHOR]

Sexual health is a prime concern whether it is population control or HIV/AIDS. Population controls as well as the HIV/AIDS campaigns have repeatedly focused on the sexual practices of the poor and the sub-altern population of the developing nations. The campaigns employed have somewhat socially constructed the normative sexual health practices for the population at large. It has in some sense, 'dictated' the population about the 'correct' sexual behaviour. A glance at the population as well as HIV/AIDS programmes flag a common agenda. It can also be observed that the developing countries have depended on the expertise of the developed nations for the programmes. Thus, the developed nations had an upper hand in 'dictating' the normative sexual health behaviour for population in the developing nations based on their own understanding of sexual health practices. It can also be observed that most of the campaigns tend to speak down to the masses rather than considering their culture. This paper attempts to understand the basic tenets of the concepts of sexual health and tries to relate it to the population and HIV/AIDS programmes in India. [ABSTRACT FROM AUTHOR]

Widows living with HIV/AIDS (WLHA) are a vulnerable and often overlooked group. The North Eastern Indian state of Manipur, which has one of the highest concentrations of HIV/AIDS cases in India, is not an exception. This paper aims to describe the pattern of and factors contributing to the use of health services by WLHA in Manipur. Structured face-to-face interviews were conducted among 510 respondents. Only 49% of the respondents were aware of available health facilities. The place of residence (67.8%) and appointment at a convenient time (70.8%) were the main factors affecting the use of health services. To improve access to health services, it is imperative that the services of trained health providers are made easily available. Policy makers and organizations working on HIV/AIDs should work together to remove the barriers to the use of health services, making them user friendly for vulnerable groups such as WLHA. [ABSTRACT FROM AUTHOR]

India has the second-largest population living with HIV/AIDS in the world. Although the exact number of HIV positive people is contested, it is predicted that the current numbers are likely to grow at a rapid rate in the next decade if the epidemic goes unchecked. This paper explores the HIV/AIDS epidemic in India through the perspective of two non-governmental organisations (NGOs) whose roles have become critical in the fight against the disease. Specifically, it identifies the challenges faced by these NGOs such as lack of government responsiveness, funding-related problems, corruption, donor accountability, and cultural attitudes to HIV/AIDS, while exploring the theoretical implications of NGOs playing a greater role in providing programming and services to those living with, and affected by, the epidemic. [ABSTRACT FROM AUTHOR]

HIV/AIDS has gained prominence in India as a growing public health issue. There is a complex but significant interaction between mental health and HIV/AIDS. HIV affects mental health by its direct neurobiological action, the impact of having the illness, by its treatment including that for opportunistic infections and by its impact on the family. In addition, substance use and mental illness as vulnerability factors add to the complexity of assessment, differential diagnosis and management. This paper reviews literature published in India on the topic. [ABSTRACT FROM AUTHOR]

With 3.1 million people estimated to be living with HIV/AIDS in India and 39.5 million people globally, the epidemic has posed academics the challenge of identifying behaviours and their underlying beliefs in the effort to reduce the risk of HIV transmission. The Health Belief Model (HBM) is frequently used to identify risk behaviours and adherence behaviour in the field of HIV/AIDS. Risk behaviour studies that apply HBM have been largely quantitative and use of qualitative methodology is rare. The marriage of qualitative and quantitative methods has never been easy. The challenge is in triangulating the methods. Method triangulation has been largely used to combine insights from the qualitative and quantitative methods but not to link both the methods. In this paper we suggest a linked trajectory of method triangulation (LTMT). The linked trajectory aims to first gather individual level information through in-depth interviews and then to present the information as vignettes in focus group discussions. We thus validate information obtained from in-depth interviews and gather emic concepts that arise from the interaction. We thus capture both the interpretation and the interaction angles of the qualitative method. Further, using the qualitative information gained, a survey is designed. In doing so, the survey questions are grounded and contextualized. We employed this linked trajectory of method triangulation in a study on the risk assessment of HIV/AIDS among migrant and mobile men. Fieldwork was carried out in Goa, India. Data come from two waves of studies, first an explorative qualitative study (2003), second a larger study (2004-2005), including in-depth interviews (25), focus group discussions (21) and a survey (n=1259). By employing the qualitative to quantitative LTMT we can not only contextualize the existing concepts of the HBM, but also validate new concepts and identify new risk groups. [ABSTRACT FROM AUTHOR]

HIV/AIDS stigma is a frequently cited barrier to HIV prevention, including voluntary counseling and testing. A reliable and valid measurement instrument is critical to empirically assess the extent and effects of HIV/AIDS stigma. The paper reports the development and psychometric testing of an HIV/AIDS stigma scale among 200 men in India. The resulting 24-item scale and the four subscales had good internal consistency (Cronbach's alpha overall was 0.81; subscales were 0.86, 0.73, 0.72 and 0.76, respectively). The scale and distinct subscales suggest a valid and reliable measure for HIV/AIDS stigma in a setting with highly prevalent HIV risk behaviors. [ABSTRACT FROM AUTHOR]

With access to prevention of parent-to-child transmission (PPTCT) and antiretroviral therapy (ARV), people living with HIV/AIDS are better able to consider childbearing and parenthood. However, there is limited understanding of the reproductive healthcare needs and the impact of infection on the fertility desires of women living with HIV/AIDS. Research on the relationship between fertility and HIV/AIDS has been largely clinical, focusing on the ability of women living with HIV/AIDS (WLHA) to conceive or their pregnancy outcomes. This paper describes the findings of a qualitative study undertaken in Namakkal district, Tamil Nadu, India that aimed to explore fertility desires, intentions and fertility decision-making in WLHA and the barriers they face in fulfilling these desires. In-depth interviews were held with selected 43 currently married WLHA aged 18-35 years and 10 key informants. The women were classified according to whether or not they had living children and, within that, whether they had experienced abortion, wanted more or any children or were pregnant. The main factors distinguishing women who wanted to have a child and those who did not were their levels of anxiety about the future and available family support. Women who indicated that they did not have family support and were stigmatised by the family were reluctant to opt for a pregnancy as they were not sure of the future, including child care in event of parental death. In contrast, those women who decided to have a child did so based on family support, especially when family members offered to take care of the child in the future in the event of parental death. Awareness and access to PPTCT and ARV was another key factor guiding the final decision on child bearing. Findings highlight the need for further research on issues faced by WLHA in fulfilling their fertility desires and intentions and for programmes that both enable WLHA to exercise informed choice in meeting their fertility desires and sensitise healthcare providers about these needs. [ABSTRACT FROM AUTHOR]

This paper evaluates the role of female sex worker (FSW) collectives in the state of Karnataka, India, regarding their facilitating effect in increasing knowledge and promoting change towards safer sexual behaviour. In 2002 a state-wide survey of FSWs was administered to a stratified sample of 1,512 women. Following the survey, a collectivization index was developed to measure the degree of involvement of FSWs in collective-related activities. The results indicate that a higher degree of collectivization was associated with increased knowledge and higher reported condom use. Reported condom use was higher with commercial clients than with regular partners or husbands among all women and a gradient was observed in most outcome variables between women with low, medium and high collectivization index scores. Collectivization seems to have a positive impact in increasing knowledge and in empowering FSWs in Karnataka to adopt safer sex practices, particularly with commercial clients. While these results are encouraging, they may be confounded by social desirability, selection and other biases. More longitudinal and qualitative studies are required to better understand the nature of sex worker collectives and the benefits that they can provide. [ABSTRACT FROM AUTHOR]

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Unlike any other disease so far, the ‘exceptional’ nature of HIV/AIDS has prompted debate about the necessity, but also the challenges, of regulating practitioner–patient communication around HIV testing. In India, the National AIDS Control Organization (NACO) has adopted the guidelines of the World Health Organization with regard to HIV testing and counselling, yet the extent to which these guidelines are fully understood or followed by the vast private medical sector is unknown. This paper examines the gaps between policy and practice in communications around HIV testing in the private sector and aims to inform a bottom-up approach to policy development that is grounded in actual processes of health care provision. Drawing on 27 in-depth interviews conducted with private medical practitioners managing HIV patients in the city of Pune, we looked specifically at practitioners’ reported communications with patients prior to an HIV test, during and following disclosure of the test result. Among these practitioners, informed consent is rare and pre-test communication is prescriptive rather than shared. Confidentiality of the patient is often breached during disclosure, as family members are drawn into the process without consulting the patient. While non-adherence to guidelines is a matter of concern, practitioners’ communication practices in this setting must be understood in the given social and legal context of the patient–practitioner relationship in India. Communication with their patients is strongly influenced by practitioners’ perceptions of their own roles and relationships with patients, perceived characteristics of the patient population, limitations in knowledge and skills, moral values as well as perceptions of legal guidelines and patient rights. We suggest that policy guidelines around patient–practitioner communication need to take sufficient cognizance of existing practices, cultures and the realities of care provision in the private sector. Patients themselves need to be empowered in order to grasp the importance and implications of HIV testing and counselling. [ABSTRACT FROM AUTHOR]

Male-to-male sexuality in India has been described as both heavily stigmatized and implicitly tolerated. This paper examines these apparently contradictory attitudes, arguing that they reflect broader moral ambivalence about homosexuality in Indian culture and society. While the effects of homophobia in India are very real, simultaneous social latitude allows for relatively un-scrutinized same-sex sexual contact. The paper explores this scenario as a post-colonial legacy and considers the consequences for contemporary sexual subjectivity, particularly in respect of irregular responses to emerging gay identities and socially ambiguous male-to-male sexualities. Conceiving of men who have sex with men as subject to both prejudice and tolerance raises complex questions for HIV/AIDS related policy, programming and activism. The paper argues that understanding male-to-male sexualities in India as practiced within a climate of ambiguous moral censure offers critical insights for the future promotion of health. [ABSTRACT FROM AUTHOR]

This paper examines the effects of current policies intended to liberalize the Indian economy and facilitate globalization on women close to poverty. The New Economic Policy of 1991 included standard structural adjustment measures including the devaluation of the rupee, increase in interest rates, reduction in public investment and expenditure, reduction in public sector food and fertilizer subsidies, increase in imports and foreign investment in capital-intensive and high-tech activities, and abolition of the cash compensatory support for exports. These policies have resulted in increased urbanization, and fewer job opportunities for women in the formal sector. Such conditions increase poverty for women in particular. As a result, many women flow into cities looking for work in the informal sector. This may have increased numbers of women in sex work, for lack of better economic opportunity. Sufficient data are not available to confirm whether HIV infection rates have risen as a result; however, the evidence suggests there may be a relationship between macroeconomic policies and health outcomes. [ABSTRACT FROM AUTHOR]

How households and families respond to AIDS is of fundamental importance when it comes to designing programmes and interventions to provide support and care to people living with HIV disease. Where household and family responses are negative, different kinds of interventions may be needed from those where responses are more supportive. This paper reports on findings from an in-depth study of household and family responses to HIV and AIDS in India. Using individual and couple interviews, data were collected on the ways in which care and support were offered (or denied) to people living with HIV and AIDS. Findings show that responses are greatly influenced by prevailing gender relations, with men being responded to more positively than women, as well as other variables such as social status. The quality of responses is also influenced by pre-existing patterns of support and discord within the family. Where trust is high and spousal conflict slight, for example, HIV and AIDS are reacted to more positively than when there is mistrust and inter-spousal conflict. Suggestions are made concerning programme and intervention development so as to strengthen existing responses, and to maximize the success of home-based care. [ABSTRACT FROM AUTHOR]

United Nations' agencies are reporting that India will become the world center for AIDS and HIV-related illnesses by the end of the century (Pais, 1996). It is predicted that in the year 2000, India will have the highest rate of infected individuals and new infections (Panday et al ., 1997). This information is daunting. AIDS and HIV-related illnesses have proven to be challenging for all nations that have had to face both the widespread epidemic and, frequently, highly infected epicenters or populations at high risk. The epidemic has seriously taxed the health systems in technologically advanced countries such as the USA. A cursory examination of this impending problem in India might lead to the obvious conclusion that it is going to be devastating. One also might speculate that there would be very little that could be done, and finally conclude that the die are cast, so that acceptance and managing the consequences are all that is left to India at this point in time. This paper explores trauma, HIV and India, and in this context addresses the impact of a traumatizing event, the HIV epidemic, on a nation and its children. [ABSTRACT FROM AUTHOR]

Introduction: Mental disorders are quite common in association with human immunodeficiency virus (HIV). Mental disorders are more prevalent in people living with HIV/AIDS (PLWHA) than the general population. The aim of this study was to evaluate depression, anxiety and insomnia in PLWHA and its correlation with socio-demographic factors and cluster of differentiation-4 (CD4) count. Material and methods: This was a cross sectional study conducted in Pt. BD Sharma PGIMS, Rohtak on 500 PLWHA in India. Hospital Anxiety and Depression Scale-Depression (HADS-D), Hospital Anxiety and Depression Scale-Anxiety (HADS-A) and Pittsburgh Sleep Quality Index (PSQI) scale were used to assess depression, anxiety and insomnia respectively in PLWHA. Five groups were designed on the basis of CD4 count: Group A (< 100 cells/µl), Group B (100-199 cells/µl), Group C (200-349 cells/µl), Group D (350-499 cells/µl) and Group E (> 500 cells/µl). Results: Prevalence of anxiety, depression and insomnia was found to be 59.6%, 61.2% and 56.4% respectively. Males had higher prevalence of depression and insomnia which are 64.2% and 57.4% respectively, whereas female had higher prevalence of anxiety (63%). There was a positive correlation between each score i.e. HADS-A, HADS-D and PSQI scale. There was a weak negative correlation between CD4 and each score. Conclusions: Despite higher prevalence, psychiatric illnesses remains underdiagnosed most of the time. Thus clinicians at the anti-retroviral therapy centre should screen these patients for depression, anxiety and depression for improvement in morbidity and mortality in PLWHA. [ABSTRACT FROM AUTHOR]

Introduction: Acquired Immune Deficiency Syndrome (AIDS) is a major health concern among Indian adolescents (10–19 years). Indian adolescents lack adequate knowledge about HIV/AIDS and adopt wrong practices. The present scoping review aims to understand the status of knowledge, beliefs and practices among Indian adolescents about HIV or HIV/AIDS. The present study will also focus on their understanding and the source of knowledge and awareness regarding HIV/AIDS. Methodology: The recommendations of Arksey and O'Malley in 2005, Levac et al. in 2010 and The Joanna Briggs Institute Reviewers' manual in 2015 to conduct a systematic scoping review will be employed. The review questions, eligibility criteria and search strategy for this study will be ensured by the Population, Concept and Context (PCC) strategy. The Preferred Reporting Items for Systemic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) will be used for reporting of this scoping review. The methodological quality of all the relevant studies will be assessed by the Mixed Methods Appraisal Tool (MMAT), Version- 2018. Literature search will be carried out by using electronic databases such as PubMed, APA PsycInfo, EMBASE, and Google Scholar. Cross-references will be used to extract additional studies. Ethics and dissemination: As the planned study is based on secondary data and doesn't involve human and animal subjects, there is no requirement for formal ethical approval. Strengths and limitations of the study: The planned scoping review is the first of such study on the topic of HIV/AIDS among adolescent population in India as per the electronically available literature. There will be quality assessment of all the included studies. A thorough search strategy will be conducted as per the recommendations of the experts in scoping review search. On limitation side, the planned study will only utilize electronically available resources/evidences that are written in English language. The planned evidence based study will be of much help for the healthcare professionals and policy makers. [ABSTRACT FROM AUTHOR]

Synopsis Over the years there have been some media initiatives in India to generate HIV/AIDS based awareness, both at the national and regional levels. Yet very little research has gone into the media based portrayals of these initiatives. Through a detailed sociological discourse analysis of two major English dailies published in east India, this paper looks at media's portrayal of a media generated social artifact—the Buladi campaign in West Bengal. In the process this research seeks to answer the following research questions: 1. How the print media's articulation of the campaign was gendered, how was it portrayed as such? 2. What are the social implications of the campaign beyond media portrayals? Two characteristics set the prospect of the current project as exclusive from literature on the subject—first, this study examines media based commentaries on yet another media generated artifact in India (a comparatively unexplored scholastic terrain). Second, this study focuses on a unique female centric HIV awareness campaign. Findings suggest that gendered implications of the Buladi campaign from the media reports are not obvious. Yes the campaign is gendered and yet the gendered interpretations are intrinsic. In particular, the campaign dispelled some social norms while to an extent it conformed to others. Irrespective, the campaign absorbed denizens of Bengal whether yielding or unyielding, to talk about a much averted social topic. The price of such media deliberations include adhering to some existing social ideas rather than forcefully injecting imported ideas (including those from the west for instance), which the social space might not be ready to receive/work with. [ABSTRACT FROM AUTHOR]

Abstract: Background: We report on the functional performance, safety and acceptability of the 90-mm Reddy female condom in two clinical trials, one in Los Angeles, CA, and one in Pune, Maharashtra, India. Study Design: Both studies used a Phase I, crossover design involving 25 couples. Each couple used three condoms of each of two shaft lengths: in Los Angeles, shaft lengths of 150 and 90 mm were used; in Pune, shaft lengths of 120 and 90 mm were used. This paper focuses on the 90-mm condom since it is commercially available. The primary endpoint of each study was invagination, defined as the outer frame of the condom being pushed into the vagina during intercourse. Secondary functionality endpoints included nonclinical breakage, clinical breakage, penile misdirection and complete slippage. Results: Invagination occurred in 26.9% of uses in Los Angeles vs. 6.8% of uses in Pune. Penile misdirection and complete slippage were reported only in Pune during 4.0% and 9.5% of uses, respectively. There were two clinical breaks in Pune and none in Los Angeles. Total clinical failure was 26.9% in Los Angeles and 23.0% in Pune. Conclusions: Two clinical studies of the 90-mm Reddy female condom suggest that its functional performance is inferior to other female condoms. [Copyright &y& Elsevier]

This paper is based on partially exploratory and partially descriptive research design to find out AIDS awareness and agreement of parents and teachers on educating adolescents about contraception techniques. For this study 60 parents and 60 teachers were interviewed from 10 different Govt. Senior Secondary schools in district Sangrur, Punjab, India. The random sampling technique was used. The knowledge of AIDS among parents was found partial. Mothers showed lesser knowledge of AIDS in comparison to fathers. Teachers showed comprehensive knowledge of AIDS. Majority of respondents disagree on educating adolescents about contraception techniques. But all responded reported to be in agreement to provide full knowledge about AIDS to adolescents. The education of contraception for adolescent found to be associated with the knowledge of prevention from unwanted pregnancy. Parents and teachers showed propensity to provide such education to adolescents which advocates sexual abstinence until marriage. The plausible reason to such perception could be that in most of Indian societies there is taboo on sex or sex related discussion. [ABSTRACT FROM AUTHOR]

While both India and Brazil are seriously affected by the HIV/AIDS epidemic, each country has chosen a different approach to providing affordable pharmaceutical treatment. Whereas the Indian government has paved the way for market-driven solutions, Brazilian public authorities are strongly involved in the research and production of HIV/AIDS medication. Brazilian regulations permit comprehensive and free provision of HIV/AIDS drugs, whereas the majority of the affected population in India does not receive adequate pharmaceutical treatment. To explain the different policy outputs, we draw on the developmental state literature. Efficient decisionmaking structures, a devoted bureaucracy, and effective policy instruments enable public authorities to provide public goods even in the context of relative scarcity. We show that the assumptions of developmental state theory have to be complemented by the assessment of civil society actors' potential to trigger governmental interventions in the market. [ABSTRACT FROM AUTHOR]

The paper discusses the management of public morality with perspective of public policy formulation processes in contemporary Judig. [ABSTRACT FROM AUTHOR]

Abstract: This report explores how vulnerability to HIV/AIDS applies to women in the reproductive age range living in the slum areas of Delhi and Hyderabad. The paper is based on a qualitative study of AIDS awareness levels conducted during the summer of 2006. It offers insightful narratives from a sample of 32 women, providing an in depth view of their vulnerability to HIV/AIDS due to their precarious socioeconomic conditions and low AIDS awareness. The women cited lack of education, low empowerment in expressing and accessing information related to sexual matters, and poverty as key factors to vulnerability. [Copyright &y& Elsevier]

Research on the linkage between migration and HIV/AIDS provides mixed results. On the one hand, there is ample empirical evidence which upholds a higher level of positive correlation between labour migration and HIV vulnerability. On the other hand, there is evidence which effaces the above inference and maintains that staying in the country of origin does not essentially reduce the risk of HIV infection. The objective of the present paper is to probe further the complex relationship between the two, and disinter various conditions of migration that contribute to increasing HIV vulnerability. The discussion is primarily based on the available body of international research pertaining to the field. The discussion reveals that there is nothing about being a migrant per se which runs the higher risk of contracting HIV virus. Rather, the underlying factors are various social and behavioural patterns of some mobile groups, which place them at a higher risk of HIV infection. [ABSTRACT FROM AUTHOR]

In 2003, India had over 5.1 million infected individuals living with HIV/AIDS. The percentage of all HW cases attributed to perinatal transmission has been increasing steadily from 0.33% of total cases in 1999 to 2.80% in 2004. Recent statistics indicate that over 180,000 infants have been infected through this route, Despite recent advances in reducing in utero and interbartum transmission with the use of antiretrovirals, there is a critical need to make infant feeding safer. Current UNAIDS/WHO/UNICEF recommendations stress avoidance of all breastfeeding if replacement feeding fulfills the key requirements of being affordable, feasible, acceptable, sustainable, and safe, In this paper, we examine how the UNAIDS/WHO/UNICEF recommendations have been actualized within the context of an urban government hospital in India. The documented patterns of infant feeding by HIV-positive mothers in Pune, India, from 2000 to 2004, highlight the complexities of making an informed and healthy choice under suboptimal conditions. The data indicate that interpersonal variations in the key requirements greatly influence the optimal practice to minimize mortality risks. Moreover, local information on health outcomes is crucial to tailoring policy recommendations to save lives. We propose the development of a decision-making algorithm that includes factors affecting mother-to-infant transmission, including site-specific data on health risks to the mother and the child. Such an algorithm would allow identification of the healthiest feeding choice and would minimize the pitfalls of promoting homogeneous practices lacking site-specific evidence-based evaluation. [ABSTRACT FROM AUTHOR]