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HIV AIDS: Where government has gone wrong, What government can do

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HIV Aids in India where government has gone wrong

Photo: The Hindu

As another world AIDS day passes by and the epidemic shows no sign of end, we need to evaluate the status of AIDS in India. Our country is one of the hotspot of acquired immunodeficiency syndrome (AIDS), an incurable syndrome that eventually befalls on large fraction of human immunodeficiency virus (HIV) positive individuals. While globally the number of AIDS patients has started to stabilize but epidemic is nowhere close to being over. This global epidemic has already turned out to be a major killer of humankind on an epic scale comparable to black death and smallpox. As per the latest estimates by UNAIDS, it is the fourth leading cause of death. In India, the state of affairs is so unsatisfactory that we still have frequent cases of mass infection of poor patients due to the negligence of hospitals, horrible mistreatment of HIV positive individuals and lack of even basic care for millions of AIDS patients. While the problems of AIDS in India are manifold and would require efforts from all the sectors of Indian society, in this article we want to bring forward key failures of the Indian government. We focus on five core issues that require immediate attention, if we wish to see the tail of this AIDS epidemic:

  1. Demographic and epidemiological understanding
  2. Awareness
  3. Screening and counselling
  4. Treatment facilities and medicines
  5. Need to develop indigenous cures

Demographic and epidemiological understanding: In India, it is difficult to trust the total number of AIDS patients, as grossly contradicting government figures makes one wonder if the actual magnitude of the epidemic is even larger than what is currently reported. The latest estimates released by the National AIDS Control Organization (NACO), an organization run under the auspices of the ministry of health, indicates that national adult HIV prevalence in India is approximately 0.29%, which corresponds to an estimated 3.4 million plus people living with HIV in our country (Annual report NACO 2009-2010). In contrast in 2005, NACO reported 5.21 millions HIV positive individuals. One can only wonder if such a change in the figures is an effort to put lipstick on the pig or there was a fundamental error in one of the two estimates. There has been some beating around the bush, blame laying and unsatisfactory explanations in response to this contradiction but if there was a genuine error then what is conclusively being done to avoid future errors, is currently not clearly known. Apart from getting the right overall numbers, what is also needed, is detailed demographic and epidemiological data. Different strains of HIV are prevalent in the different parts of the world and progression of AIDS is also different in people of different genetic background, for example there is a very small fraction of people that innately do not contract AIDS. Such trends of immunity to AIDS are either absent or currently not known in the Indian population. It is rather appalling that in India, the land that holds genetic diversity next to the continent of Africa, we for some silly reasons have been using data solely from the White Caucasian populations. This over dependency on western data is wrong for three reasons: 1) The strains of HIV prevalent in different regions are different, 2) The genetic diversity of India makes comparison to one ethnic group meaningless and 3) Apart from the Anglo-Indians with significant European heritage, no ethnic group in India, whatever be their surname and notions of self identity, share that close of genetic identity with the European populations to justify the current usage. What is needed is to understand the spread of different strains of HIV in India and the progression of diseases in individuals with a different genetic background.

Awareness: The first case of AIDS in India was diagnosed way back in 1986. Subsequently some apparent movement of bureaucratic and political machinery took place that in the following year resulted in the formation of National AIDS control program (NACP). In reality, the understanding of Indian government and media on the danger of this disease was largely missing until recently and is still rather poor. Even till late nineties, it was not entirely uncommon to hear voices in the Indian media claiming that AIDS is likely a trouble of promiscuous foreign lands and not of a conservative India. The media and the government forgot that this land of billion plus is first the land of Kamasutra and then of Gandhian moral curtains. Such ethnic biases that come wrapped in moral judgments cost lives everywhere. Even in the United States, initially AIDS was largely thought to be a disease of homosexuals and Afro-Americans, a curse of God for the decadent. In India, the lackadaisical approach in dealing with AIDS was also due to undermining the spread of HIV through blood transfusion and not realizing the severity of needle sharing by drug addicts and poor hospital administrative/clinical measures. As an addition to the existing policy, firstly the government needs to be aware of the full cost of AIDS and then it needs to take action to better inform the health care professionals and public at large. Media also adds to the trouble by rarely looking beyond less glamorous issues than some odd cricketing century of Tendulkar or birth of Bachchan granddaughter, occasionally mentioning somewhat sensational denial of basic services to HIV positive individuals or some innocent people being infected at a mass scale, instead of serious discussion of issues. Serious discussions, even when managing to creep in from the nooks and crannies of the sensational mainstream news, fails to gather attention beyond one media cycle.

Is this lack of information spread, a result of lack of resources or is it due to lack of political will? A significant chunk of taxpayer’s money on AIDS, like any other resource in India has been squandered with significant chunks making it to the chauffeurs of the corrupt. Lack of adequate money is definitely a problem, but a relatively minor one, compared to the mismanagement of the available resources. An approach for awareness, with low cost and huge promise, is the proper training of health care professionals. Mandatory improvements in the syllabus of medical schools and compulsory training of health care professionals to be better deal with immunocompromized AIDS patients, providing all medical services to HIV positive patients and to counsel patients on screening and precautions can be a game changer. While some namesake changes have been made in some medical curricula of advanced training but none to the internationally acceptable standards and barely any that impact primary care providers dealing with majority of patients. Formulation and implementation of laws against discrimination of HIV positive patients is also needed urgently. Another dimension of information dissemination and care is to focus on special groups. Recent international attention and support from charitable organizations along with government of India’s initiatives on free distribution of condoms to sex workers has been very productive. Successful select programs are currently targeting high-risk populations like truck drivers and sex workers but the biggest group with this affliction is currently ignored. This group is of the displaced urban poor migrant workers who are forced to work in non-native cities and seek sexual favours in questionable places. In a nation, that is busy unsuccessfully dealing with the symptoms of poverty and displacement, by the means of handouts that reach only select few and harassment to silence dissent, one needs to cure the actual disease of poverty that accentuates problems such as AIDS by means of holistic socio-economic development.

Screening and counselling: Roughly 85% of new infections are via the heterosexual route and efforts towards premarital counselling for HIV can reduce half to three fourth of this spread. In Goa and Andhra, the high prevalence states, the state governments proposed bills in 2006 to make HIV testing compulsory before marriage, but ethical concerns and political issues have thus far stopped the actual implementation. This issue of mandatory testing poses a real ethical concern as on one hand we do not have any patient confidentiality where people are denied their due rights due to their HIV status and on the other hand, who can justify the infection to innocent spouses, mostly females via their less than faithful counterparts? One needs to evolve a system where an employer and an insurer, cannot know the HIV status of the patient but a spouse can. It is not going to an easy nut to crack for any government, leave alone Indian, but the administration has not even started inching in the right direction of evolving such a mechanism.

Treatment facilities and medicines: National AIDS control program (NACP-III, 2007-2012) of India has a total budget of about 2.6 billion dollars but only a minor fraction of it is for the treatment. This is unacceptably low amount of money being spent on treatment, especially the amount that finally trickles down the bureaucratic apparatus. One may wonder what do we mean by treatment of an incurable syndrome? The progression of HIV positive individuals to AIDS is very different. Once patient contracts full blown AIDS his/her survival can vary from months to decades. This survival, apart from patient to patient variability, depends on the availability of antiviral drugs and treatment facilities. It is possible that India may have lost much of its potential to produce generic and cheap anti-retroviral relief due to twists in the international politics and India’s easy compliance with pressures. It is possible that recent aid to African countries to counter AIDS, has likely come with strings attached as they have almost stopped use of cheaper generic anti-retroviral drugs. Indian anti-retroviral drugs that were much cheaper than Western products have not just lost a market in Africa but their share in India is also tapering. We would recommend evolution of an informed policy that considers efficacy and costs of all compounds with the goal to save as many lives as possible.

Need to develop indigenous cures: Let us focus on vaccines, a preventative approach that actually holds a long-term cure of AIDS. While there have been some sporadic islands of successes in the ocean of failure in finding vaccine for AIDS, the international efforts are finding new promises and ruling out failed ideas with every passing day. We wonder why not a single significant effort worthy of mention is being pioneered in India? Given that we as Indians have become comfortably numb to the thought of India as a second or third grade country that is a recipient of high-end technology and fruits of scientific research, an average Indian, even if bluntly reminded of the state of affairs, howsoever offended, will not break sweat for long about the lack of innovation. The concern is far graver than the lack of innovation and the lack of national pride. If we need vaccine for AIDS, as soon as it is available in the West, unlike the case with polio or smallpox, we cannot take our begging bowl to world as we did in early years after independence or grossly overpay our way out, as we frequently do to procure any technology, ranging from our medicines to our warplanes. The problem with HIV vaccine stems from to the issues of demographics and epidemiology. Different strains of HIV are prevalent in different parts of the globe. HIV is very diverse, in fact some strains only show 40% homology between each other, not that different of genetic homology between you and a banana and in fact less than you and an earthworm. Thus to combat a hyper-mutable virus one needs to work on local strain and keep local population genetic profile and overall epidemiology in mind to solve the AIDS epidemic in India.

Will India rise to the challenge novel anti-retrovirals and indigenous vaccine? Likely not. Even in the well developed sectors like information technology, India only delivers small software packages for foreign products and does not manufacture a single major internationally recognizable product. This is not due to dearth of scientists or of money. In fact, India has very high numbers of biomedical scientists and research institutions spread across the country for the size of its economy. The problem is of incompetence, lack of management, corruption and nepotism. The political infestation of research is palpable in Delhi where corruption and lack of accountability permeates all levels of research epithet. One need not go into the obvious appointment of unqualified vice chancellors and administrators of universities and directors of research institutes based on proximity to political parties in power. A look at say, the University of Delhi University, a supposed prime University of India, can give you an idea of the political stooges running the show of research in India. Apart from corrupt management, there exist a large number of the so-called scientists who do not have a single major internationally known finding to their name but are busy sliding papers in “friendly” obscure journals and frequently get awarded national and regional honours. This abysmal state of affairs keeps very successful and patriotic scientists out of this Indian swamp that is sure to kill any good science.

In summary, current government efforts are either missing or misplaced and are largely wrought with corruption and inefficiency. A significant blow can be landed to AIDS epidemic with effective government policies. We hope that this article along with many other efforts raises awareness of public and its representatives for better combating the scourge of AIDS.

Dr. Sukant Khurana is a New York based scientist, artist and writer of Indian origin. His basic research involves neurophysiology, computational neuroscience, sensory perception, addiction, learning and memory, while his applied research extends into many areas of drug discovery and problems of the developing world. Both his visual art and writing explore the issues of modernization, displacement and identity.

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Inventor of a liposuction technique, Dr. Dario Bazzano shares tips on cosmetic surgery

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According to the American Society of Plastic Surgeons (ASPS), the percentage of cosmetic surgery performed in the United States between the years of 2000 and 2018 remained relatively constant. These include surgeries like breast augmentation and liposuction. On the other hand, less invasive procedures such as botox and chemical peels have increased 228 percent in this same period.

In face of such data, it seems that Americans are preferring an approach more orientated to aesthetic medicine, that is, techniques that are less invasive and therefore risky. But there’s good news: Dr. Dario Bazzano, an aesthetic surgeon with 17 years of experience and more than 4,000 operations performed, has invented and patented a technique of liposuction called “biolipospectrum.”

Less invasive and more efficient than the options more commonly available in the market, “biolipospectrum” allows the skin to contract more, reduces or eliminates bleeding (thus allowing a great percentage of fat to be eliminated) and offers a much quicker postoperative recovery time. In fact, the surgery takes only about two hours and is not very painful or invasive. According to Dr. Bazzano, patients could have the surgery on a Friday, for example, and Monday or at the latest Tuesday, they could be going back to work yet.

However, as experienced and serious as Dr. Bazzano is, there are other challenges he faces at work than the complexity of surgeries. The surgeon says that oftentimes, girls show up with retouched photos of themselves or even pictures of celebrities. Sometimes, says the doctor, the requests are even excessive and may indicate a distorted view of the patient over their own body. “In that case, professional seriousness demands refuse to perform the intervention,” he adds.

The most popular requests in the clinic include breast augmentations (reconstruction of the breast through a prosthesis) and liposculpture or lipofilling and abdominoplasty. “In short, everything related to the correction of body shapes,” adds Dr. Bazzano. After these two types of operations, there is also a lot of interest in blepharoplasty, which is the reconstruction of the inner part of the thighs.

But since these procedures involve surgery and relatively invasive techniques, what is the best way to choose the professional? Dr. Bazzano says that people can check publications and also take a look at photos of previous interventions performed by a professional, but beware of retouched photos. “They look better than the ‘raw’ photos, but these are nevertheless capable of showing the reality of the facts, as opposed to photos that are pleasing to the eye, but decidedly artificial,” advises the surgeon. Finally, Dr. Bazzano says that it is important that the patient trusts the doctor and that there is empathy between them, which means cosmetic procedures are not just about technique, but also about human relationships.

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Benefits in the measurement of strength and speed exercises

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Preparing and actual work are vital in day to day existence, regardless of whether for expert or novice competitors. For a right observing of how we are improving and arriving at various levels, there is the chance of estimating the speed and strength that we are acting in every daily schedule. Choices like Vitruve permit us to quantify the preparation, and today we will discuss the advantages that this implies for charting and playing out our schedules.

What is Vitruve?

The Vitruve training enconder is a device that unites the latest in estimation innovation with precision in terms of monitoring information about the space traveled and the movement time of an external load. By merging it with our activity program, it allows us to explicitly know how we are progressing based on the factors of strength, mechanical work, endurance or speed.

With the assistance of Vitruve, information and a fitness coach, we can additionally alter our active work schedules to benefit from them. Yet, taking these estimations additionally brings us different advantages when we train.

How linear encoders work?

Linear encoders are dynamometers that are used within the sports context to carry out direct and continuous measurements of the space traveled by an external load (bars, weights, dumbbells… among others), taking into account the time during which it occurs said displacement. Through a series of calculations, the device will provide you with a series of variables that will allow you to measure the performance of your exercise session, thus helping to evaluate the changes in strength that you may experience as your training progresses.

The results provided by linear encoders are characterized by very low errors, making these devices extremely useful tools for the most dedicated powerlifters. It must be taken into account, however, that the error that we can find in the results is derived from the inclination when lifting the free weights. In the event that we deviate the trajectory of the weight by 5 degrees, for example, the results would suffer an error of 0.38%.

These devices are an ideal investment for all those who seek to make the most accurate measurements possible on the evolution of their physical condition when undergoing training. The truth is that the degree of precision and guarantees provided by the numerous scientific studies that validate the results of linear encoders more than justify the purchase.

Vitruve encoder: affordable model with endless benefits

Despite the many advantages of using a linear encoder for physical exercise, it is true that some drawbacks can be mentioned at the same time that make us reconsider this purchase. These disadvantages disappear when we take into consideration the Vitruve brand of encoder, designed to solve some of the main problems that these products usually have.

First of all, we have to mention that the use of a normal linear encoder requires a laptop computer. However, the Vitruve encoder manages to work completely independently, making its use much more accessible by not forcing us to carry a laptop with us wherever we want to perform our training. 

In return, the Vitruve device shows the calculated results through a display, information that can be complemented with what we get from synchronizing the encoder with our Android or iOS phone through the Vitruve app. In case it bothers you to rely on a mobile device, you should know that the data you have access to thanks to Vitruve’s display includes the calculations of average propulsive speed, maximum speed, repetition number and encoder battery.

Another concern that may arise before deciding to purchase this encoder is the minimum sensing distance. When we do a weight lifting exercise, it is possible that the encoder does not detect the effort made by not exceeding the minimum distance required for the device to detect a repetition. This is not a problem for the Vitruve encoder, as it includes an option to modify the centimeters you want it to detect in a repetition.

Thanks to the use of the Vitruve encoder you can experience a number of benefits, including an increase of up to 20% of the 1RM (maximum weight that can be lifted in a single repetition), reduced risk of injury by using the optimal load, increased explosiveness and reduction of up to 60% of the recovery time, among others.

Undoubtedly, Vitruve offers athletes a very valuable tool with which to get the most out of their strength training, obtaining very detailed information about their performance that will allow them to progress at a faster rate. If you also want to take advantage of all that the Vitruve encoder has to offer, don’t think twice. Taking into account all these advantages together with the fact that, compared to the rest of the competition, the price of the Vitruve encoder is much more affordable, the purchase decision becomes much more obvious.

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Mitigating The Effects Of Harmful Health Issues

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Self-care is very often seen as a proactive process, that is, in order to succeed in it, you need to perfect each day, to work out hard, to get perfect sleep, and to eat properly. Sure, you might not be able to live up to perfection in this way, but it is good to use that as a proper rule of thumb going forward.

That said, sometimes, we’re not in the right stage of our lives to just think that’s all we need. After all, if you’re managing a health condition, a habit that has harmed your health, or you’re suffering from the effects of health mismanagement over the years, it can be tough to return to that baseline and know how to go on from there.

Any self-care advice, then, is incomplete unless it properly understands this and leverages guidance to people just looking to improve, no matter what relative point they may currently occupy. Thankfully, there are ways to get the most out of this, and in this post, we hope to discuss how to mitigate the effects of harmful health issues so you can return to an appropriate normal:

Identify That Which Is Holding You Back

It’s good to figure out exactly what it is that’s holding you back, in its full scope. After all, we cannot make progress if we’re fooling ourselves, or haven’t fully understood the issue. For some people, this might mean collecting the courage to attend a medical checkup. After all, for some people, this can be a worrying process.

This is especially true as we get older, and the necessity for more regular medical checkups are required. Men in their 40s are usually known for being quite flimsy about having issues seen to, fearful of prospective health issues and what that might mean for their overall sense of robustness and wellbeing. That’s a generalization, however, as it’s true that anyone can experience health anxiety and want to delay facing that kind of clinical inspection to the degree that they can.

That said – it’s best to view this in its full scope. You might find that your drinking habits have gone unchecked for a small while, and you need to actually record how much you’re consuming and spending to understand how deep the problem lies. With the help of trusted relatives, friends and objectively noting that which is troubling us, we can come to a better understanding.

Ask For Help If Necessary

We can often think that harmful health issues must be dealt with in stern silence, but that’s not true at all. If you ask for it, help is out there. From relief programs to the simple guidance of a friend willing to take you to your checkups or meetings, you’d be surprised how many people can and will pull together to help you through a tough spot if needed. Asking them to do so can be the first step, be that attending drug rehab or physiotherapy sessions.

Find A Step-By-Step Recuperative Program

Finding a step-by-step recuperative program you can use to gain potential and increment your progress can be worthwhile in helping you avoid trying to do this all on your own. For instance, a weekly meeting with a therapist can be key towards managing old behaviors and building the new in its place.

Managing Quality of Life

It might not be that you can live the life you had before, but that’s not to say you should feel totally disconnected from the quality of life you deserve to lead. Through appropriate exercise, leveraging the support you’re entitled to, keeping optimistic, and engaging fully with a course of treatment or lifestyle guidance, as well as using the internet or support groups to discuss with people who actually understand, this process can be much more manageable, no matter your condition.

Believe In Better

Ultimately, your attitude will determine how well you make it through this process and reclaim your own potential. Sure, you should never be blamed for suffering an optimism hit once experiencing a real-life malady, such as becoming newly disabled with a condition, but it’s important to recognize that life is not over.

Believing in better and making do with the best of what you have, though it’s easy for us to type and harder for you to live, can be a great way of finding your renewed joy and lightening your spirit so that your condition becomes part of your life, not the defining factor of it. You would be amazed at how this intent can leverage results.

With this advice, we hope you can mitigate the effects of harmful health issues, using a range of practical steps, social aid, and motivational willingness. You’ve got this.

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