Prevention of Parent to Child Transmission - Overview of HIV/AIDS in India

It has been estimated that out of 27 million pregnancies in India, nearly 189,000 occur in HIV-positive mothers, leading to an estimated cohort of 56,700 infected babies (Joint Technical Mission on PPTCT). PPTCT program using Nevirapine was initiated in the country in 2001. However, by 2004, only 3.94% of all pregnant women received HIV counseling and testing, and only 2.35% of the HIV-positive pregnant women received antiretroviral drug prophylaxis. [10]

PPTCT program has been scaled up in the country with Nevirapine as the regimen of choice. With single-drug regimen, there has been a reduction of perinatal transmission of HIV from 40% to 11-13%.

With effective ART, elective cesarean section and exclusive breast feeding, it has fallen to 2%. [13] Although the regimen is simple to deliver and has an efficacy rate of 48% in prevention of HIV transmission in the mother-baby pair, data suggests that there is increased drug resistance to ART in mothers who were treated with prophylactic single-dose Nevirapine. [10] A preliminary report from South Africa suggested that reducing viral replication by combining single-dose Nevirapine with postnatal AZT/3TC may lower Nevirapine resistance in women to about 10%.

Awareness Regarding HIV/AIDS Status
Eighty-six percent of the Indian population is unaware of their HIV status. Only 57% of the general population and 80% of commercial sex workers are aware of preventive methods.

Stigma and Discrimination in India
A 2006 study found that 25% of people living with HIV in India had been refused medical treatment on the basis of their HIV-positive status. It also found strong evidence of stigma in the workplace, with 74% of employees not disclosing their status to their employer for fear of discrimination. Of the 26% who did disclose their status, 10% reported having faced prejudice as a result. People in marginalized groups - female sex workers,  hijras (transgender) and gay men - are often stigmatized not only because of their HIV status but also because they belong to socially excluded groups.

There is an urgent need to do more and to do it better, so that the results of our efforts can be counted in millions of infections prevented; millions of people living with HIV/AIDS living more productive, healthy lives; and millions of children, so heartlessly orphaned by the disease, being properly cared for. - Paul Wolfowitz, President, World Bank, November 2005

Marfatia YS, Sharma Archana, Modi Megha
Department of Skin and VD, Medical College and SSG Hospital, Vadodara, India

Correspondence Address:
Marfatia Y S
Department of Skin and VD, Medical College and SSG Hospital, Vadodara
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