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LATEST NEWS UPDATES | Prevention proof in HIV study by GS Mudur

Prevention proof in HIV study by GS Mudur

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published Published on Oct 12, 2011   modified Modified on Oct 12, 2011

A five-year effort to promote condom use by sex workers and their clients and the use of safe needles by drug users may have helped India prevent about 100,000 HIV infections, according to a study to be released tomorrow.

The study suggests that the high-profile HIV prevention initiative called Avahan, funded by the Bill and Melinda Gates Foundation and implemented in six states, was less effective in Nagaland, Manipur and Maharashtra than in Andhra Pradesh, Karnataka and Tamil Nadu.

Public health researchers who estimated HIV prevalence in the six states in 2003 and 2008, before and five years into the Avahan initiative, said the results show that prevention aimed at high-risk groups can reduce HIV prevalence in general population.

The researchers used a mathematical model and epidemiological data from antenatal screening clinics across the six states to compute the impact of the initiative.

The results, published today in The Lancet, a peer-reviewed medical journal, suggest that Avahan contributed to reducing HIV prevalence in the general population — the highest reduction by 12.7 per cent in Karnataka and the lowest by 2.4 per cent in Maharashtra between 2003 and 2008. The reduction was 5.9 per cent in Manipur and 4.1 per cent in Nagaland.

“We believe the relatively lower benefits in the Northeast may have been due to difficult geographic terrain and the scattered populations there,” said Lalit Dandona, a community medicine specialist at Public Health Foundation of India, and research team member.

The researchers said their findings are significant because they highlight the benefits of HIV prevention efforts at a time when funding for prevention has stagnated while funding for HIV treatment has “increased heavily” over the past five years.

“Sparse evidence for the benefits of prevention may have contributed to this stagnation in funding,” Dandona told The Telegraph. “This study shows that prevention also deserves more resources — it has effects across the general population.”

The $258-million Avahan initiative focussed on high-risk groups such as sex workers and their clients, men who have sex with men, and drug addicts who use injections.

The initiative facilitated safe-sex counselling, distribution of free condoms, needle and syringe exchanges through peer outreach programmes as well as provided treatment for sexually transmitted infections which can raise the risk of HIV transmission.

The researchers used a technique called counter-factual analysis in their model to estimate the impact of the Avahan initiative — simulating scenarios in the absence of Avahan while holding the government’s own control efforts steady.

Their calculations show that Avahan averted about 100,000 HIV infections in India during the five years but the study’s limitations inject a fairly large uncertainty over the figure — the number of infections prevented could be anything between 25,800 to 207,700.

In 2009, the Gates Foundation announced an additional $80 million to facilitate the merger of Avahan with the government’s own HIV control programme by 2013.

The Telegraph, 12 October, 2011, http://www.telegraphindia.com/1111012/jsp/nation/story_14613521.jsp


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