Medical College Kottayam

The discovery of the disease "AIDS" in the U.S was viewed with lot of skepticism by the Kerala public in the beginning. Everybody thought this is never going to occur in our country, leave alone create an epidemic. When the first AIDS case was reported from Chennai and Mumbai, people were very complacent, and were quick to associate this with CSWs(Commercial sex workers - and the foreigners. We the medical people also linked all our cases to a metropolitan or foreign connection. That was the period when we noticed the disease amongst the youth of our villages who never had any of the above contacts, albeit known. The days passed by and we are now seeing large number of our villagers coming up wit HIV infection. By the time they come their wife and children are already infected too. Because of this frequency of events and the spilling over of AIDS cases to the newly married girls of India, that people are now thinking "getting married" is the major risk for an Indian woman. And the number of children getting infected is also on the rise.

Figures ????

What you read above is the observation shared by many of us. But when it comes to real solid figures, we are almost in the dark. The National AIDS Control Organization (NACO), New Delhi says 76481 HIV positives had been identified up to April 1998. The number of AIDS cases (persons with opportunistic infections / malignancy) is 5209. The projected figures based on Sample surveys, Sentinel surveillance, statistical projections etc. are 3 million and 30,000 respectively. This is because only a small number gets to the hospital or health network. (Of the infected lot only one percent is expected to be symptomatic / aware of the disease at anytime).

What happens to an infected person?

As soon as HIV (Human Immunodeficiency Virus) gets into the body, it starts proliferating inside certain cells (CD4 cells). These are gradually destroyed over long periods (two to 20 years). As these cells are the master cells of immunity, the person lose the immune power and become susceptible to all sorts of infections. The CD4 cells were the original group of cells thought to be infected, but many new types with other receptors (gates which permit viruses to go in) are being identified. Once infected the person remains as a carrier of the virus throughout his life, as the virus gets bound to the human DNA (gene material) permanently.

As days and years pass by the immune dysfunction leads to the person developing certain disease that are common in the community, then some hidden infections from the patient's own body and then certain diseases which do not occur in healthy humans at all. These diseases are called opportunistic infections (e.g. Candidiasis, Pneumocystis Carinii Pneumonia, a type of fungal pneumonia, Cryptococcosis, Cryptospoiridiosis etc..). Some of them develop certain cancers (e.g. Kaposi's Sarcoma, Primary Lymphoma of Brain etc..). When an HIV infected person develops one of these we call the person as having AIDS.

1. IEC (Information, Education & Communication) aimed at the behavioral change in the public the only real solution for preventing further spread.

2. Condom promotion activities

3. Training of Medical, paramedical staff on aspects of diagnosis, clinical features, management including counseling and hospital infection control practices.

4. Blood safety - by ensuring the replacement of professional donors with voluntary donors, institution of compulsory screening and restriction of blood donations.

5.Surveillance - aimed at finding out the trends amongst the high and low risk groups and

6. Reduction of impact amongst the infected - PLWS (Persons living with HIV / AIDS)

The State AIDS Committee headed by the Chief Secretary (to be replaced by the AIDS Society shortly) is in charge of all AIDS related activities in the state.

The State AIDS Cell a division of Health Services is located at Red Cross Road, Thiruvananthapuram (headed by The State AIDS Program Officer - Additional Director Health Services)

The State Physician Responsible for AIDS Management (PRAM) is the consultant on clinical issues. The author is holding the post now.

In each District, the District AIDS Committees (under the chair of the District Collector) and the Dist. PRAM hold charge of district level activities. Various NGOs are also associated with various activities.

Right now these persons are receiving the benefit of Counseling, Home care and treatment of associated diseases like Tuberculosis, Fungal infections etc. As theantiretroviral drugs (Azidothymidine, Lamivudine, Saquinavir and Indinavir) are available but very very expensive, there are only a handful of patients receiving them in the whole state. The use of AZT (alone) in preventing vertical transmission is likely to be introduced shortly, it's hoped.

As this is an ever-changing field, all of this is subject to changes and correction very frequently. Please keep visiting the site regularly for updates. And your queries are welcome.