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India’s HIV success story, but new concerns for children living with HIV

1st December 2011 is World Aids Day and many HIV/AIDS organisations and groups are publishing updates on their work in tackling the disease.

According to the recently published UNAIDS report, the news is generally positive. Worldwide, annual HIV infections have fallen 21% between 1997 and 2010, and more people than ever are living with HIV, with better access to treatment.

In Asia, where HIV prevalence is lower than in many other regions, the news is also positive. In South and South-East Asia, an estimated 270,000 new infections in 2010 represented a decrease of 40% compared to numbers at the epidemic’s peak in 1996. India has the largest number of HIV/AIDS cases (because of its size) and here, the fall in new HIV infections was 56%.

This decline in India is partly due to the targeting of populations at higher risk of infection. For example, an Alertnet article highlights how India has scaled up efforts to control the spread of the disease among sex workers. This has involved programmes for improving access to contraceptives and medical treatment, as well as raising awareness in the sex industry by involving women in these communities. A new study by the World Bank – Cost Effectiveness of Targeted HIV Prevention Interventions for Female Sex Workers in India – estimates that such activities could mean 3 million fewer HIV infections over the next 20 years. Such estimates are formed by looking at the success of localised prevention programmes; for example, in the southern state of Kerala, HIV prevalence has dropped from 25% to 13% among female sex workers. And an initiative in Mumbai has seen a drop from 45% to 13%.

However, the news isn’t uniformly positive from India and other Asian countries. A study carried out by TREAT Asia (covering India, Thailand, Vietnam, Malaysia, Cambodia and Indonesia) found that children as young as five were developing a resistance to AIDS drugs. In the study, first-line drugs were found to be ineffective in around 14% of child patients and even children under the age of five were being put on second-line drugs. Speaking to Reuters, the director of TREAT explained that mistakes were made in the early days of managing HIV, where children were given adult tablets, rather than paediatric quantities of medication. Unless third-line drugs are made available, the director warned that for some children with resistance, there would be “no other drug to give them”.

The TREAT study also carried out X-rays on Asian teenagers and young people and found that a high percentage had low bone mineral density. For example, in the 16-year old age group or thereabouts, around 15% of HIV patients had low bone mass from the effects of the disease or possibly from the drugs. This means that HIV sufferers are likely to develop osteoporosis at a very young age. TREAT therefore called for further research to be carried out into side effects and into the monitoring of how different drugs affect patients.

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