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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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How To Help Reduce Stress In Life

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Keeping out stress from your life is easier said than done. There are a lot of things in life that can make you feel under pressure or gives you that feeling of being overwhelmed. However, you can take control of some of these situations, so here are a few tips on helping reduce stress in your life.

Take Time Out For Yourself

Taking time out is essential and something that will certainly help you feel more like yourself and less like a robot. We can move through life feeling like we’re doing the same things day in and day out. Eat, work, sleep, and repeat. But that can be changed if you make more time for yourself. Stop putting others before you and every so often, perhaps once or twice a week, try and give yourself an hour or even an afternoon to yourself. Whatever time you can spare, no matter how busy you get, do something for you. It can help change the way you feel about your life currently, but more importantly, it helps bring you a little calm and peacefulness in your life, just like https://www.tprf.org/prem-rawat/ mentions.

Eat Well And Exercise

Exercise and eating well are essential to reducing stress levels because sometimes what we eat and do to our body can shift how we’re feeling on the inside for the better. Think about what you’re eating currently and how you can change that in order to feel better about yourself. Try to incorporate more fruit and vegetables as a rule and cut out things that are maybe doing more harm than good for your body. It doesn’t mean you can’t treat yourself every now and then, though. Make sure you’re exercising each day, too, even if it’s walking up the stairs to your office every day. Getting blood and heart pumping is important and can help with stress.

Find Your Guidance

Guidance is something we all need at points in our lives. It helps us find a route to a problem we’re having or to navigate ourselves out of a bad place. Finding that guidance is important, whether it’s through a self-help book, speaking to a friend, or visiting a professional. Find your guidance that will help you focus on how to reduce stress in both a physical and mental way.

Give Your Mind A Reality Check

Finally, when we’re feeling stressed, we can often feel a lot worse than what we should be feeling, and that’s because our minds tend to make the situation ten times worse. So when it comes down to it, it’s important to focus on the positives and to remember the good things that you have in your life. Stress can sometimes overshadow that and make us forget how good we have it sometimes, even if it’s only something small, it’s significant.

Reducing stress in your life is a life-long battle for all of us, but a few tips like these can help minimize the overall stress we feel in life.

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Electrospinning: the most advanced method of drug delivery

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electrospinning drug delivery

At the pharmaceutical level, the need to improve and refine the methods of drug delivery in the body is an area of great importance. Unlike people commonly assume, the effectiveness of a drug is not based solely on its composition, but on its method of application. 

This fact becomes clear if we look at the different presentations that a drug can have regarding ways of being supplied. Likewise, in the creation and composition of the drug for therapeutic use, the best and most efficient ways of providing the treatment are evaluated. 

The need for a drug delivery system that controls and directs the active pharmaceutical ingredients is becoming increasingly evident to achieve a decrease in the adverse side effects of treatment. An example, the need for control in the release of drug’s API into the body is what happened to cancer patients.

The treatment against cancer is hugely abrasive to the patient’s body, and therefore, its administration must be strongly dosed to decrease the intensity of the adverse side effects in the person. However, this also reduces the effectiveness of the treatment.

Delivery directed specifically to the area of the tumour, increasing the effectiveness of the drug and reducing adverse effects. Different methods of encapsulation have been tested but have marked limitations that allow only reduced variables to be controlled, such as the speed of drug delivery to the body once ingested.

The technology of electrospinning drug delivery breaks with the limitations of the previous methods of encapsulation achieving a controlled, directed and even programmed administration in the body. These benefits are due to the variety of materials that can be processed by electrospinning and the structural variations of the capsules, creating a significant variety for drug delivery in the body. 

What is electrospinning

Electrospinning is a fibre manufacturing technique. It works with electromagnetic principles by subjecting substances to high voltages to generate an electrostatic charge in the material that ends up resulting in the formation of the nanometer fibre as a product of electrostatic repulsion and surface tension of the solution.

Electrospinning has several uses because of its property of being able to produce a great variety of fibres with significant differences from each other without changing the method. Although it was initially used for the manufacture of textiles has expanded to other areas such as the manufacture of batteries. Even combine the fibres with building elements such as concrete because of its high strength due to mechanical stress that is subjected to the material in its manufacture.

However, it is in the area of nanomaterial production where its maximum utility is highlighted since nanomaterials present particular interactions depending on the material, and it is at such scale where cellular processes occur. This reason is why medicine, more specifically pharmacology, benefits greatly from such technology. 

In pharmacology, two types of drugs are sold (differentiated by application according to the fibre), dressings and tissues, both of which can be manufactured with the production of fibres derived from electrospinning. 

Differences between electrospinning and other methods for drug delivery

Notable drug encapsulation methods include spray-drying, freeze-drying and emulsification, which are easily recognizable on sight since most consumer drugs are distributed in such presentations. Each one has his own characteristics that make it more suitable for one type of drug than another, and each one has its limitations.

These methods are based on the preservation and dosage of the drug. Such as freeze-drying, which is the procedure of preservation by cryodrying, or emulsification, which consists of mixing immiscible liquids. While such forms of encapsulation work efficiently to preserve the drug and deliver it to the body, their reach goes there. 

Electrospinning systems for drugs delivery work in two ways, by mixing the bioactive compound, i.e. the drug with the polymer solution before applying electrospinning or after the creation of the fibre by coaxial processing. This method allows the efficient supply of the drug’s API as it benefits from the surface-volume area due to the dependence on the surface area where the application of nanofibers is favoured. 

The drug release profiles are highly adaptable to various applications by varying the solution of the polymer with which the nanofiber is created and controlling its area and volume. This process will allow the distribution of drugs that are released in response to chemical stimuli even hours after they have been ingested, that target specific areas if created with magnetic components, and even facilitate their production on a large scale since the other methods find it difficult to produce them massively.Innovation in fibre production in the pharmacological area will create more significant and more efficient scope for the medication of many diseases, improving the treatment of the patient and increasing its effectiveness. Electrospinning technology admits a wide range of natural and synthetic polymers for processing, in turn, lowers production costs, allowing for greater distribution of medicines to various sectors of the population.

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Things that you need to consider before having a lumbar disk replacement surgery

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lumbar disk spinal chord

In the world are many people who have difficult or problem with their spine. For that reason, is very common to see people having a lumbar disk replacement surgery recovery, after having had an intervention in the operating room to improve their health conditions. This kind of surgery usually doesn’t represent a risk for patients, but sometimes is necessary to know aspects that need to be considered before having this surgery.

A surgery is needed?

Spine problems can generate pain and make people have an unhealthy posture. This makes necessary to solve any problem associated with it to have a great life condition and to avoid any risk associated with spine diseases. Unfortunately there are many people who, for one reason or another, need an intervention in the operating room, due to the wear on their spine

Is a solution to many spine problems that could be generating difficulties or pain to patients. Recovery from lumbar disc replacement surgery requires that the patient receive rehabilitation for a few months for optimal results. This surgery has a fast recovery and doesn’t represent any risk of having it. It is a way to ensure the recovery of the spine; even about 80% of people can return to sports.Therefore, it’s normal that professionals recommend it as the first way to cure any disease related to the spine.

Despite all this, there are some indications or information that people need to know before having a lumbar disk replacement surgery. This will make the patient be more confident about this surgery and will make them to pass all this process with no difficulty. 

Here you will find full information about some things that need to be present before having this type of surgery. This will be essential to have the best process and have a fast surgery recovery.

What kind of things are necessary to consider before having a lumbar disk replacement surgery?

The degeneration of the parts of the spine can cause many health problems that, in the long run, they can bring serious health diseases. Therefore, having a lumbar disk replacement will be beneficial to patients. Despite this, is recommended to consider some aspects before decide or not to have this type of surgery.

Some main aspects that you need to think about before having this type of surgeries, are:

  • Find the best center: it’s necessary to consider many spine centers that can do this surgery with no problem. Also, is recommended to compare all options to determine which will be the best for your needs. This will help you in the surgery recovery and to avoid any possible risk.
  • Collect any information about the surgery: it’s indispensable to collect all the information about this surgery. For example, any risk, costs, recovery plan and the knowing about if this replacement will fix any health problem or disease.
  • Determine the quality of the artificial lumbar disc: it’s necessary to know the quality of the object that will be used on the surgery. This will understand any possible risk using this artificial product and will let you know if is the best option at this moment.
  • Ask for not intrusive solutions: if you have any problem with the lumbar disk or the spine, it’s recommended to have a not intrusive treatment, instead of having a surgery or disk replacement. Therefore, try to only have surgery at the last option. 
  • Find a plan of recovery and prevention: have a lumbar disk replacement has its problems and risk. Therefore, always it’s recommended to follow some recommendations and plans to keep your spine healthy. All this can be determined by a professional in this area, which will give you the correct information and indications about the after surgery treatment. 
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