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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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7 Secrets to Setting Realistic Goals this Summer

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Summer is a great time of year to get motivated. The sunny weather is often inspiration enough and helps you start to feel more positive about your goals. Even though you might be taking a break from your studies or work, or planning a relaxing vacation, you can use the time to reflect on your plans for the future. Learning how to set realistic goals is the first step towards achieving them. Why not spend a bit of time outdoors in the park with your day planner and get a head start this year? Here are seven tips to get you going.

Seek inspiration in new places

Setting goals is challenging if you’re not feeling inspired. Lucky for you, it’s the perfect time of year to embrace the outdoors and seek motivation and inspiration in new places. Traveling is one of the best ways to get inspired. Even if you’re not going abroad this year you can explore hidden gems near you. Try seeing your hometown through the eyes of a tourist or getting lost in areas of natural beauty. You’ll return feeling relaxed and rejuvenated and ready to take on any challenge.

Spend more time outdoors

Spend plenty of time outdoors this summer. Getting in touch with nature can be very motivating and there are several health benefits of being outdoors. It’ll help you gain a fresh perspective and improve your mood. You’ll also get physical exercise which will give you the energy boost you need. You could even try out a new outdoor hobby or sport this year. Enjoy a healthy dose of vitamin D and get yourself in a more positive mindset.

Practice meditation

Meditation involves many useful techniques to help you focus. In order to prioritize and set realistic goals, you need to clear your mind of cluttering thoughts and improve your concentration. If you’re new to meditation you could try listening to a guided meditation. This will teach you the necessary skills you need to practice meditation on your own. You can then do this anytime and anywhere, even outdoors. Here is a guided meditation for goal setting.

Set measurable goals

Now that you’ve got yourself in the right mindset to make a proper plan you can get focused. It’s important to set measurable goals, whether they’re related to your studies, work, or health and fitness. This will help you track your progress and stay motivated. You could try following the SMART goals model. This states that all goals should be measurable and time bound, not to mention specific and relevant to you at the moment. If your goal is to look for jobs, for example, set yourself a certain number of applications per week. Break your goals down into tasks and set a deadline for each.

Be mindful of your health

Be mindful of both your mental and physical health this summer. Stress can get in the way of setting goals and can have a negative effect on your overall well-being. If you are feeling stressed or anxious try to get the root of the problem. If it’s health related you could try speaking to a doctor online about any number of issues from mental to sexual health. You can even order an HIV test kit or other prescriptions. Be proactive about your health and this will give you the peace of mind you need to stay motivated.

Keep your brain active

Even though it’s summer vacation and the weather is nice, it’s important to keep your mind sharp. There are plenty of fun activities you can try even if you’re taking a break from work or studying. Find some interesting new reads or even learn a new skill. You could take on a creative craft or DIY project this summer. There are also fun things you can do with friends such as geocaching or an escape room that will help you boost your problem-solving and critical thinking skills.

Get out of your comfort zone

Try something different this summer and get out of your comfort zone. Whether it’s learning a new skill or doing an activity you wouldn’t normally, this can be a great way to boost your self-esteem. Getting out of your comfort soon will help give you the confidence you need to motivate yourself to set and achieve the right goals. You could even try volunteering in the local community. This can be very rewarding and inspiring and will help you gain perspective. Find the activity that works best for you.

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Chronic Pain: How To Regain Control Over Your Life Naturally

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Chronic pain is estimated to affect over 50 million Americans and is becoming an even more popular condition. Due to our lifestyles, posture, exercise level, and diet, an increasing number of people have started to suffer from chronic pain. In some cases, pain can be minimal and only represent a minor inconvenience. However, in some other cases, chronic pain can take over your life and be so overwhelming that it might prevent you from enjoying even the easiest daily tasks. Depending on the cause behind it, chronic pain can develop from mild to severe. Therefore, while there is no definitive cure, chronic pain needs to be addressed. Here are five non-invasive ways to find chronic pain relief naturally. 

Understand the Underlying Causes

Firstly, it is crucial to understand what are the causes behind your chronic pain. You might have been the victim of an accident, or you might have reported injuries that haven’t healed. Alternatively, an inactive lifestyle and bad posture can also lead to lower back, sciatica, and leg pain. 

In some cases, some chronic diseases such as cancer and arthritis might be the cause behind the pain. Before trying to find a solution for your pain, it is crucial to understand what is the underlying cause. This will help you avoid unnecessary painkillers and move towards a longer-lasting solution.  

Use Meditation and Breathing Techniques

One of the main factors that can worsen your chronic pain is stress. Indeed, stress causes damage to cells and leads to increased free radicals. In turn, these can worsen inflammation and prevent your body from healing. 

Breathing techniques and meditation are mindfulness practices that allow you to focus on your breath, repeat a mantra, or focus your attention inward. This can allow you to avoid additional stress and reduce inflammation.

Aim To Move Your Body Regularly

Regular exercise is essential to allow your body to release endorphins – the happiness hormone! These compounds are the ones responsible for the famous “runner’s high” and act as mood regulators. In turn, this can reduce stress levels and allow you to feel more balanced. Exercise is also essential to help you get rid of any extra weight you might be carrying. By doing so, you can lighten up your body, which takes pressure away from your muscles, joints, and bones. And of course, it can help you reduce the risk of conditions such as heart disease. 

Consider a Plant-Based Lifestyle

Studies have proven that whole grain, plant-based lifestyle can reduce fatigue and chronic pain. Indeed, fruits and vegetables are famously filled with the antioxidants your body needs to reduce inflammation and the damaging effects of free radicals. Speaking to your nutritionist allows you to get started in the right way. 

Try Medical Marijuana

Medical marijuana has been seen to help with certain kinds of chronic pain. If you are affected by severe chronic pain which is impacting your life, or you have an underlying condition such as arthritis or cancer, you might be able to obtain a medical marijuana card. You can learn all about Harvest House of Cannabis and how to apply for a medical card here. 

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Unconventional Ways to Boost Your Health

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With health tips and diets around every corner, it can be hard to know what the best course is going to be for your body. Between fad diets and finding the best workout gear, it can be overwhelming. Finding the specific rhythm to support what your body needs is going to be a lifelong journey, but there are things that you can do to get off to a good start.

Establish a Baseline

In order to know what specific health goals you need to have, you first need to establish a baseline. It is important to start with the basics and make sure that you are making generally healthy choices before you can start getting more specific.

Even though each person is different and will require different health goals, there are some things that are in common across all bodies. You need to be getting enough sleep. Not getting enough sleep can mess with your health in surprising ways. You also need to be drinking enough water each day. Most people are not drinking enough water. Being dehydrated can cause you to overeat and to be fatigued during the day. You may be surprised to see how just changing your sleep and water intake patterns can give you an extra boost.

You should also make healthy eating choices and try to get some exercise. If you are just starting on your wellness journey, then you should take small steps. If you try to take on too much at once, you will likely not be able to sustain the change.

You can start by adding more vegetables to your meals instead of trying to change what you eat. Even if you continue to eat like normal, but add in more vegetables, you will eventually be able to change your diet more drastically. You can also try switching to only drinking water instead of any other kind of beverage with your meals. This will also help with your water intake.

For exercise, you don’t have to go running, even though that is probably what pops into your head first. You can start by just doing stretches before bed or going for a walk during your lunch break. Start where you are and then build on that.

Talk to Your Doctor

You should make sure that you go to your regular checkups with your doctor. If you have concerns about specific health issues, then discuss them with your doctor. If you are looking for advice in general, you can ask what their biggest concerns are and where your focus should be for improvements. They have insights into your health that can help you on your path to wellness.

Environment Changes

There may be changes you need to make to your environment in order to be functioning at one hundred percent. You should have your home tested for toxins and hazardous gases to make sure that you are not breathing in anything that may be harmful to you. You may also want to be asking questions like, What is the Safe Distance From Wifi Router? Or, does my electrical wiring need to be updated. Making these changes can improve your health if there is something happening that shouldn’t be happening. You may be surprised to find out how your health can change when these silent issues get resolved.

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