Health Policy Issues and Health Programmes in ... - Amazon S3

HIV/AIDS: International Perspectivemoney on health care. In Thailand and Burkina Faso, agricultural income in rural areas isdwindling. In Burkina Faso, an estimated 20% of the rural population fails to cultivate their landbecause of AIDS-related morbidity and mortality.The adverse impact of AIDS is not restricted to economic-generating sectors alone. Therehas been a – five to six – fold increase in illness among health workers in Malawi andZambia, and similar trends were observed in other professions. In a study in the CentralAfrican Republic, 85% of the 300 deaths documented among school-teachers wereattributable to AIDS.The epidemic impacts uninfected children as well because of the sickness or death of one orboth parents. Because children need to care for their ailing parents and economic constraintsincrease, school drop-out rates, particularly among girls, are mounting in many Africancountries. South Africa and Malawi had to emphasize free primary education by offeringstudents a second chance to enroll in order to overcome this problem. In South Africa alone,12.1 million children have been orphaned by the death of one or both parents.This brief overview makes it clear that HIV/AIDS poses a serious threat with far-reaching socioeconomicimplications in all parts of the world. Although the scope of analysis of this evidencefor the purpose of contributing to policy formulation is enormous, we limit it to a set ofcontext-specific (the focus is on the low prevalence and border-location characteristic ofUttaranchal) questions.1. Are some populations immune to HIV?2. Can prolonged low prevalence indicate that there is no threat of a serious epidemic?3. Does border location add to vulnerability?4. What fuels and drives the epidemic?5. Do preventive efforts produce results?1. No population is naturally protected. There is neither biological nor epidemiologicalevidence to suggest that, once exposed, an individual or a population can escape HIV infection.However, the misconception that HIV is a disease of others and cannot infect “us” is commonamong both individuals and administrators of nations. As illustrated above, the infection is atvery low levels in some nations, such as Pakistan and Bangladesh (0.09 and 0.02%, respectively).In these situations, people tend to convince themselves that HIV is an imported infection.Notwithstanding the question of whether HIV infection is imported or indigenous, it isimportant to consider whether high-risk behaviour exists in the reference population and whatthe magnitude of such behaviour is. This can be assessed by the level of indicator diseases suchas STIs and hepatitis B and C, whose routes of transmission are similar to those of HIV. Forexample, the prevalence of hepatitis C in Pakistan is 89%, the average partner turnover of CSWsin Bangladesh is three per day, and STIs are exhibiting an unprecedented increase in some areasof China. In Jakarta, the percentage of sexually active male school students increased from 7%in 1997 to 25% in 1999. Once the virus gains a foothold in such a population, it will not be longbefore it establishes itself as an explosive epidemic.172