Bioethics in India: Proceedings of the International Bioethics Workshop in Madras: Biomanagement of Biogeoresources, 16-19 Jan. 1997, University of Madras; Editors: Jayapaul Azariah, Hilda Azariah, & Darryl R.J. Macer, Copyright Eubios Ethics Institute 1997.

26. Prevalence of HIV in women in Chennai attending antenatal clinics

D. Sudarsanam and S.A. Christian Shirley*.
Department of Zoology, Loyola College, Chennai 600 034
*YRG Care Centre for AIDS Research and Education, T. Nagar, Chennai 600 017

The World Health Organization in 1979 declared that we would have "Health for all" by 2000 AD. The reason was we had conquered small pox. It has been eradicated from the face of this earth. Humankind thought we were the most powerful, but within two years by 1981 the first case of a new disease `AIDS' was detected. It was first diagnosed among the "Gay community" in USA. In India in the early 80's we believed that a disease which affects people with risk behaviours like homosexuals, intra venous drug users and prostitutes will not get foot into India. We, in India believed that this disease will not affect us and that our culture, traditions, religion and values will protect us from this disease.

Unfortunately, in 1986, the first HIV positive case was detected in India in Madras among prostitutes. We still believed that this disease will only affect persons who had multiple sexual partners like the prostitutes, long distance lorry drivers etc. But today from the sentinel surveillance (Suniti Solomon, 1994) it is very clear that this disease has increased tenfold among those with high risk behaviour and 2 to 3 fold among the general population. With this in mind this study was undertaken among the general population of antenatal women.

In our study, out of 101 antenatal women tested for HIV, one showed the presence of HIV antibody by ELISA which was confirmed by LIATEK technique. ELISA is a screening test, it is rapid and simple but not specific. There are chances of `false positive' results. Fortunately if ELISA is done properly it does not give `false negative' results.

Repeated ELISA positive samples are confirmed using Western Blot, LIATEK, or Fluorescent antibody absorption technique. In this study LIATEK was used. The advantage of this technique is, it differentiates between the two types of HIV viruses I and II. In this case the results showed the women was infected with HIV.

It has been found that 70% of HIV infection is among young people between the age group of 15-29. In our study the age of HIV positive person was 25 years and the woman with VDRL reactive was 19 years old. This can be explained by the fact that there is a curiosity and excitation among young people who are more sexually active.

Among the 101 women, 34 were below the age of 20 and majority were between 21 and 25 years. The one HIV positive detected among this group was 25 years old and the VDRL reactive woman was 19 years old, both were housewives. 57 women were primi-gravida and VDRL reactive was a Primi-gravidam, whereas, the one who was HIV positive was having her second child. Medical history revealed the HIV positive woman had suffered sexually transmitted disease and also gave a history of white discharge. It is very clear from the study of Suniti Solomon (1992) that HIV seropositivity is more among people with genital ulcer disease. HIV seropositivity subjects like the one in our study with single contact history of her husband are also at risk since the man has multiple sexual partners. This shows though the housewives have a steady male partner should still be a vital target for intervention efforts. This 25 year old woman found to be HIV positive also gave a history of loss of weight and suffering from tuberculosis. It has been noted that the most common opportunistic infection in India among people with AIDS is tuberculosis, about 61% (Suniti Solomon, 1995) of instances of tuberculosis in this HIV positive person.

HIV infection prevalence rates vary widely in different geographic area and population groups. According to the available information, the major concentration of infection remains in Bombay and other parts of Maharashtra state which may contain 5% to 10% of the country's infected individuals. The other known hot spots are Pune, Madras and Vellore where local research groups have conducted similar studies among commercial sex workers.

Among the female population without specified risk, antenatal women, the rate of HIV infection in Bombay is 1.5% and in Madras it is 1%. Our study confirms the fact that 1% of antenatal women (general population) are infected with HIV.

This study has clearly shown that STD/HIV has trickled into the general population and house wives are infected. This explains that HIV is no more a disease of those with high risk behaviour, as these housewives have had only a single steady partner. Since there is no cure nor a vaccine for HIV, this reveals that preventive interventions, education and awareness should not only target risk population but also to the general population. Only then we can control diseases like STD, HIV and HBV.

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