1

EXECUTIVE SUMMARY.

Executive Summary: The research was carried out to know awareness of

AIDS among unorganized labor. The research was done for our new client who wanted to know myths/misconception, usage of condoms, awareness of AIDS. The sample for the research was between !" # labors. It was a dipstick

research to know the media habits of unorganized labor. The source of research was through primary data and secondary data. $rimary data was found with the help of %uestionnaire and secondary data was source through &A'()&ational AIDS control organization*, websites of whosea)world health organization south east asia*. The primary research was carried in +arious ,huggies in and around south Delhi. The result of the research was not shocking as three"fourth of the T.A. has neither any clue of AIDS nor they ha+e heard about it. T.A. has got +arious myths about condom like it is harmful for woman or there is no need to use condom with your wife. The only way out from this disease is by gi+ing peer to peer counseling in +illages. 'ondom should be promoted to remote areas. 'ounseling should be gi+en at +arious blood banks in India that you should always get your blood screened for transfer or replacement. The best media for the T.A. will be radio as they spend most of time at teashops gossiping with

their friends and usually we can find radio at these teashops. The most +ulnerable group, which came out from the research, is women. So there is a need to educate women at a early age.

INTRODUCTION TO HIV/AIDS AND CONDITION O HIV AIDS IN INDIA.

I!tr"#ucti"! t" t$e re%earc$ t"&ic.

The -I./AIDS epidemic represents the most serious public health problem in India. There is no denial of the enormity of the problem. The pre+alence of the infection in all parts of the country highlights the spread from urban to rural areas and from high risk to the general population. It is estimated that as on mid /001, .# million Indians were infected with the +irus. 2igration of labour,

low literacy le+els leading to low awareness, gender disparities, pre+alence of se3ually transmitted diseases and reproducti+e tract infections are some of the factors attributed to the spread of -I./AIDS. 4lobally, since the first AIDS case was detected in 5SA in /01/, the -I./AIDS epidemic continues its e3pansion across the globe with appro3imately /6!!! new infections a day. As of December, /000, 7-(/5&AIDS estimates that .6

million adults and children ha+e been infected with -I. all o+er the world and /6. million deaths ha+e occurred due to AIDS since the start of the epidemic.

HIV/AIDS i! I!#ia The first case of AIDS in India was detected in /016. Since then, -I. infections ha+e been reported in all States and union territories. The second decade of the epidemic is marked by heterogeneity. It is made up of a number of epidemics and in some places, within the state. The epidemic shifts from the high"risk population to bridge population )clients of se3 workers, STD patients and

partners of drug users*. And then to the general population. There is a time lag of 8" years between the shift from one group to another. The epidemic continues to shift towards women and towards young people with an accompanying increase in +ertical transmission and pediatric -I.. 9ocusing on the future of the epidemic is comple3. :ow le+els of infection in a large population like India can translate into large numbers of new infections. 'urrently, the estimated -I. infection rate among adult population between /#" ;0 years of age is !.<=. The burden of AIDS cases is beginning to be felt in the states affected early in the epidemic.

MEANIN' O AIDS.

Mea!i!( ") AIDS.

AIDS )ac%uired immunodeficiency syndrome* is the late stage of infection with human immunodeficiency +irus )-I.*. AIDS can take more than 1"/! years to de+elop after infection with -I.. -I."infected people can li+e symptom"free li+es for years> howe+er most people in de+eloping countries die within three years of being diagnosed with AIDS. -I. is transmitted mostly through semen and +aginal fluids during unprotected se3 without the use of condoms. 4lobally, most cases of se3ual transmission in+ol+e men and women, although in some de+eloped countries acti+ity remains the primary mode. ?esides , -I. can also be transmitted during drug in,ection by the sharing of needles contaminated with infected blood> by the transfusion of infected blood or blood products> and from an infected woman to her baby @ before birth, during birth or ,ust after deli+ery. -I. is not spread through ordinary social contact> for e3ample by shaking hands, tra+elling in the same bus, eating from the same utensils, by hugging or kissing. 2os%uitoes and insects do not spread the +irus nor is it water"borne or air"borne. According to 7-( estimates, by end"/006, nearly ! million people @ including

o+er 8.# million children @ had been infected with -I. since the start of the pandemic. A+ery day, more than <!!! adults and #!! babies are infected. 2ore than 1 million people ha+e de+eloped AIDS.

(f the 86.1 million adults with -I. infection @ the global estimate in end"/006 @ /; million were in Sub"Saharan Africa and more than .# million in Asia. (ur

region, that is South"Aast Asia, is likely to suffer the brunt of the pandemic " being home to o+er half the worldBs population. 2oreo+er, -I./AIDS is now present in e+ery continent and in e+ery region of the world. AIDS affects people primarily when they are most producti+e and leads to premature death thereby se+erely affecting the socioeconomic structure of whole families, communities and countries. ?esides, AIDS is not curable and since -I. is transmitted predominantly through contact, and with practices being essentially a pri+ate domain, these issues are difficult to address. AIDS was first recognized in the 5nited States in /01/. -owe+er, it is clear that AIDS cases had occurred in se+eral parts of the world before /01/. A+idence now suggests that the AIDS epidemic began at roughly the same time in se+eral parts of the world, including the 5.S.A. and Africa

DEMO'RA*HY O INDIA.

Population: Age structure:

1,029,991,145 (July 2001 est.) 0-14 years: 33.12% (male 175,630,537; female 165,540,672)

15-64 years: 62.2% (male 331,790,850; female 308,902,864)

65 years and over: 4.68% (male 24,439,022; female 23,687,200) (2001 est.)

Net rate:

migration -0.08 migra t(s)!1,000 "#"ulati# (2001 est.)

Sex ratio:

At birth: 1.05 male(s)!female

under 15 years: 1.06 male(s)!female

15-64 years: 1.07 male(s)!female

65 years and over: 1.03 male(s)!female

total population: 1.07 male(s)!female (2001 est.)

Total rate:

fertility

10

3.04 children born !oman "#00$ est.%

&'( A')S

* 0.,- "$... est.%

adult pre+alence rate: &'( A')S people * 3., million "$... est.% li+ing

!ith &'( A')S: &'( A')S deaths: / 3$00000 "$... est.%

11

O+,ECTIVE O RESEARCH.

O+,ECTIVE O RESEARCH: The ob,ecti+e of the research wereC

To know about the awareness of AIDS among targeted audience. To begin transforming the attitudes of the community )and targeted groups such as the medical profession* in general towards -I./AIDS and people who are diagnosed as -I.D.

12

To know about the +arious myths on how -I./AIDS spreads. To know the buying beha+ior of the organized and unorganized labor for condoms. To know which is the most powerful brand of condom among the targeted audience. To know the media habit of the targeted audience, so that the e3posure of the ads are made in those mediaEs.

13

Re%earc$ Met$"#"-"(y:

Met$"#"-"(y:

The research was carried out in +arious ,huggies) 4handhi camp, &izamuddin, :abor colony )4urgoan*,AII2S ,huggies, AII2S footpath, etc*. Fesearch was based on unbiased sampling +ia two main instruments.C /. Guestionnaire. 8. In"depth inter+iews.

Re%earc$ Ty&e: A3ploratory as well as descripti+e.

Data S"urce%:

*rimary S"urce%: The research was based on a wel structured %uestionnaire which was made on the basis of a guide before the formation of the %uestionnaire along with in depth inter+iews were conducted among the labors to know the awareness about AIDS.

Sec"!#ary S"urce%: The secondary data was collected from +arious web"sites )&A'(, 7-(SAA )who South Aast Asia*, 5&AIDS*. 2oreo+er collected

informations from a research conducted by &A'(.

14

.ue%ti"!!aire De%i(!. (n the basis of the ob,ecti+e of the research a %uestionnaire of /0 %uestions was designed" all the %uestions were open ended. &o %uantitati+e techni%ue was used. The %uestionnaire is a structured %uestionnaire. It was basically formed to know the awareness among the target audience.

C"--ecti"! ") Data. The primary data was collected by personal inter+iew and by means of the %uestionnaire prepared. The con+ersation was carried out in -indi. Aach labor took nearly 8# @ ! minutes to fill the %uestionnaire.

Sam&-e Si/e: The sample size for the research was

# labor. As the entire

%uestion in the %uestionnaire comprised of open ended, therefore none of the statistical tools were used. All the %uestion were sol+ed by using simple pie charts.

15

ACTS AND I'URES RE0ATED TO AIDS

16

9acts and 9igures

5&AIDS estimated that in /006, more than /! million women worldwide had been infected with -I. since the start of the epidemic, out of a total of o+er 8# million infected adults. 7omen accounted for ;8= of the o+er 8/ million adults li+ing with -I..

7orldwide, the -I. risk for women is rising.

In industrialised countries, practically all infections used to occur in men. &o longer. 7hile women comprised around /8= of the AIDS cases reported in 9rance in /01#, ten years later this figure rose to around 8!=. In Spain, womenEs share of reported AIDS cases more than doubled o+er the same ten"year period " from around <= to /0=.

?razilian women ha+e e3perienced an e+en more spectacular increase in risk. 7hile only one woman was infected for e+ery 00 men in /01;, a decade later women accounted for a %uarter of all those with -I..

Asian women face an enormous challenge from their regionEs runaway -I. epidemic. Typically, one"third or more of prostitutes in cities in 'ambodia, India and Thailand are infected. A+en among women who are not occupationally e3posed, the risk is growing. &ationwide in Thailand, in

17

/00/, fewer than /= of pregnant women attending antenatal clinics were found to be infected. ?y /00#, the figure was more than 8=.

In Africa south of the Sahara, there are already 6 women with -I. for e+ery # men. 'lose to four"fifths of all infected women are African.

In the younger age brackets )/ #"8; years*, the -I. risk for African girls is e+en more disproportionate. In countries where youngsters account for 6!= of all new infections, young women outnumber their male peers by a ratio of 8 to /.

7omen are close to half of the adults worldwide who daily become infected. And o+er 0 out of /! infected women li+e in a de+eloping country.

2ore than four"fifths of all infected women get the +irus from a male se3 partner )heterose3ual transmission*. The remainder become infected from a blood transfusion or from in,ecting drugs with a contaminated needle.

Studies in Africa and elsewhere ha+e shown that many married women ha+e been infected by their one partner " their husband. Simply being married is a ma,or risk factor for women who ha+e little control o+er

18

abstinence or condom use at home or their husbandEs se3ual acti+ity outside. 7omen with a se3ually transmitted disease )STD* like gonorrhoea are often unaware of it because the infection is HsilentH. 'onclusi+e proof now e3ists that STDs facilitate the spread of -I.. An untreated STD in either partner increases by up to /!"fold the risk of -I. transmission during without a condom. The STD epidemic, with thus fuels the AIDS epidemic. million new cases a year,

As of / (ctober , 8!!! , /#80 0 AIDS cases ha+e been reported in south east Asia region> more than 0#= of which were reported from ,ust three countries, namely Thailand, India and 2aynamar.

act% a1"ut HIV/AIDS 2'-"1a-

;.; million people were li+ing with -I. at the end of /000, the ma,ority )#8.#=* of whom are men.

#.; million people were newly infected with -I. in /000, of whom 1!!,!!! were in South and South"Aast Asia.

19

8.1 million people died of AIDS in /000, among them /./ million men, /.8 million women and #!!,!!! children.

/1.1 million people ha+e died of AIDS since the beginning of the epidemic.

/ .8 million children under the age of /# ha+e lost their mothers or both parents to AIDS since the beginning of the epidemic.

-I. infections, AIDS cases and deaths in men outnumber those in women in e+ery geographical region e3cept sub"Saharan Africa.

(+er 1#= of -I. infections world"wide occur through se3 between men and women and between men.

#= " /!= of -I. infections world"wide result from the sharing of needles and syringes by people who in,ect drugs, four"fifths of whom are men

-I. is more easily transmitted se3ually from men to women than +ice +ersa. (n a+erage, men ha+e more partners than women.

20

A+ery STD causes some damage to the genital skin and mucous layer, which facilitates the entry of -I. into the body. The most dangerous areC "

Syphilis 'hancroid 4enital herpes 4onorrhoea

AIDS pre+ention campaigns often fail women by assuming that they are at low risk, or by urging pre+ention methods that women ha+e little or no power to apply, such as condom use, abstinence and mutual fidelity.

21

0ATEST I'URES O *EO*0E SU ROM AIDS IN INDIA.

ERIN'

HIV/AIDS

Survei--a!ce

i!

I!#ia 3a% re&"rte# t" NACO4

22

A% "! 56t$ ,u!e7 8668

T$i% AIDS CASES IN INDIA Cumu-ative 2A:AS 9A2A:AS T"ta8<8!8 10#1 59:96 M"!t$ ;80 /6; ;<5

RIS=/TRANSMISSION CATE'ORIES N". ") *erce!tae Se3ual $erinatal transmission ?lood and blood products In,ectable Drug 5sers -istory not a+ailable T"ta-: S. N". / 8 ; # 6 < 1 0 /! // /8 / /; ca%e% !# ! 168 //# // 8 8;1 59:96 1;.; 8. 1 ./0 ./ 6.1< :66.66

State/UT Andhra $radesh Assam Arunachal $radesh A I & Islands ?ihar 'handigarh )5T* Delhi Daman I Diu Dadra I &agar -a+eli 4oa 4u,arat -aryana -imachal $radesh Jammu I Kashmir

AIDS Ca%e% /#6< /;0 ! 8/ /81 #;! <!8 / ! 16 /6;; /10 06 8

23

/# /6 /< /1 /0 8! 8/ 88 8 8; 8# 86 8< 81 80 ! / 8

Karnataka Kerala :akshadweep 2adhya $radesh 2aharashtra (rissa &agaland 2anipur 2izoram 2eghalaya $ondicherry $un,ab Fa,asthan Sikkim Tamilnadu Tripura 5ttar $radesh 7est ?engal A,bad 2un.'orp. T"ta-:

/; < 86< ! 1<1 <18 18 8;6 //88 81 1 /#< 8! ;8< ; /666< 8 #<6 1 / 86< 59:96

A(e (r"u& Ma-e !"/; yrs 1;# /#"80 yrs 0!16 !";; yrs /#!81 L ;; yrs 88; Total 8<8!8 M SourceC www.naco.org

ema-e # / ;8!! 6;1 #00 10#1

T"ta/ <6 / 816 /16<6 8188 6/6!

>HICH IS THE VU0NERA+0E 'ROU* TO HIV IN ECTION THAT CAME OUT ROM RESEARCH.

24

VU0NERA+0E 'ROU* TO HIV IN ECTION.

+i"-"(ica- vu-!era1i-ity.
Fesearch shows that the risk of becoming infected with -I. during +aginal without a condom is as much as 8"; times higher for women than men. 7omen are also more +ulnerable to other se3ually transmitted diseases. As compared with men, women ha+e a bigger surface area of mucosa e3posed during to their partnerEs se3ual secretions. )In women, the genital mucosa is the thin lining of the +agina and cer+i3.* And semen infected with -I. typically contains a higher concentration of +irus than a womanEs se3ual secretions. This makes male"to"female transmission more efficient than female"to"male.

Nounger women are at e+en greater biological risk. Their physiologically immature cer+i3 and scant +aginal secretions put up less of a barrier to -I.. Tearing and bleeding during, whether from Hrough se3H, rape or prior genital mutilation )female HcircumcisionH*, multiplies the risk of -I. infection.

Throughout the world, women run a similar risk from unprotected anal . Sometimes preferred because it preser+es +irginity and a+oids the risk of pregnancy, this form of se3 often tears the delicate tissues and affords easy entry to the +irus. A final important biological factor is an untreated STD in either partner, which multiplies the risk of -I. transmission by up to /!"fold. ?etween half and four fifths of STD cases in women go unrecognized because the sores or other signs are absent or hard to see and because women, if they are monogamous, do not

25

suspect they are at risk. A+en when symptomatic, STDs in women often go untreated.

S"cia- a!# ec"!"mic vu-!era1i-ity.

?iologically +ulnerable does not mean it is ine+itable, as past e3perience has shown that both men and women can be helped to a+oid -I.. Around the world, infection rates ha+e been lowered by screening blood for transfusion, by frank information about how -I. can spread, by clear pre+ention messages urging abstinence, fidelity or safer se3, by condom promotion, by needle e3change programmes for drug users, and by encouraging and enabling people to get prompt care for STDs. -owe+er, for millions of women, many ser+ices are inaccessible or una+ailable, and many of the messages irrele+ant or inapplicable. ?ecause of their Socio" economic circumstances, womenEs autonomy is often crippled. :acking economic resources of their own, and fearful of abandonment or +iolence on the part of their male partners, they ha+e little or no control o+er how and when they and hence o+er their risk of becoming infected with -I.. This is the meaning of +ulnerability. A woman in a stable relationship who is economically dependent on her partner cannot afford to ,eopardise his support e+en when she suspects he has -I.. If she refuses him se3 or asks him to use condoms, she is breaking the conspiracy of silence that surrounds his e3tramarital acti+ity " or, e+en worse, intimating or

26

admitting that she was unfaithful. And while some men agree to use condoms, many react with anger, +iolence or abandonment. A further dilemma is that condoms are incompatible with pregnancy. 'ouples wanting children need to know their -I. status and, if both are uninfected, agree to remain faithful or refrain from unsafe e3tramarital se3. (bstacles are unwillingness to discuss these issues openly and a lack of +oluntary -I. testing and counselling ser+ices. 2illions of young girls are brought up with little understanding of their reproducti+e system or the mechanics of -I./STD transmission and pre+ention. A+en when human is taught at school, girls are often at a disad+antage because, especially in de+eloping countries, they are taken out of school earlier than boys. At the same time, girls are taught to lea+e the initiati+e and decision"making in se3 to males, whose needs and demands are e3pected to dominate. 2ale predominance often comes with a tolerance for predatory, +iolent. It also carries a double standard whereby women are blamed or thrown out for infidelity, real or suspected, while men are tacitly e3pected or allowed to ha+e multiple se3 partners. 9ailure to respect the human rights of girls and women in terms of e%ual access to schooling, training and employment opportunities reinforces their economic dependence on men. The reliance may be on a Hsugar daddyH, a husband or stable partner, a few steady male partners who ha+e fathered the children, or, for women in prostitution, a succession of clients.

27

$rostitution constitutes another setting in which women ha+e little power to protect themsel+es from -I.. 4irls forced or sold into se3 work, e+en before puberty, are generally unaware of the AIDS risk and unable to run away or take protecti+e action. The e3ploitation of girls is one of the most pernicious forms of child abuse. &ot all prostitution is forced. 7hile for some women it is a choice, many turn to occasional or steady se3 work as an alternati+e to dire po+erty, e3changing se3 for the basic necessities of life for themsel+es and their children. Indeed, for girls and women in many cultures, se3 is the currency in which they are e3pected to pay for lifeEs opportunities, from a passing grade in school to a trading license or permission to cross a border. 7hile many se3 workers risk +iolence or loss of income if they re%uest condom use, in some places prostitutes ha+e banded together to demand condoms from all clients, or work in s where the go+ernment has instituted a Hcondoms"onlyEH rule. Ironically, these women may en,oy more protection than housewi+es who ha+e no Hsocial permissionH to re%uest or negotiate safer se3.
Ta1-e %$"?i!( t$e c"--ecti"! ") +-""# t$r"u($ V"-u!tary a!# Re&-aceme!t D"!ati"!% #uri!( t$e year 8666.

S. N".

STATE

VO0UNTARY TESTED HIV REACTIVE ! ;!# ! 0

RE*0ACEMENT TESTED /!6; 0611/ 8; /8# ; HIV REACTIVE ! /!0 ! 86

TOTA0 TOTA0 TESTED 8##! /#1<; 0<! 866 0 TOTA0 HIV @ REACTIVE ! /;01 ! # !.!! !.0; !.!! !./

/ 8 ;

A I & IS:A&DS A&D-FA $FADASArunachal $radesh ASSA2

/;16 6/168 <8< /;/!#

# 6 < 1 0 /! // /8 / /; /# /6 /< /1 /0 8! 8/ 88 8 8; 8# 86 8< 81 80 ! / 8 ; #

?I-AF '-A&DI4AFDADFA I &A4AF -A.A:I DA2A& I DI5 DA:-I 4(A 45JAFAT -AFNA&A -I2A'-A: $FADASJIK KAF&ATAKA KAFA:A :AKS-AD7AA$ 2AD-NA $FADAS2A-AFAS-TFA 2A&I$5F 2A4-A:ANA 2IO(FA2 &A4A:A&D (FISSA $(&DI'-AFFN $5&JA? FAJAST-A& SIKKI2 TA2I:&AD5 TFI$5FA 5TTAF $FADAS7AST ?A&4A: A-2ADA?AD 2.'. '-A&&AI 2.'. 252?AI 2.'. T"ta-

/661< 8 80 /0 60

28 ;!<<! 8;0;;

;0 /;0

#<;#< ;18 < ! ! / <!1# <<6! 8<#!8! 1/8 8 /;# 0 ! 8;061< /800 ; ! #</8# 8/8611 /;<68 /<80 16 ! //86 /!<!!# #!0 110 ! //#/8; 000 !;!0< /!6 1 /#66; < #60 /#/00 ! // 1!0 8BAA6:<

61 8/1 ! ! 0#8 //8 /8!/ #; /< ! / 16 #8/ ! /8< 8116 8<< / 6/ ! /8< 86 8;; ;6 8 0! 8< ;; 81 <8 ! /<1! :5C9C

!./8 !.;#

81/6! 88<1 /!0!;# 8!! ! 6;/8 /!16</ ;66#8 0!8 /8186# 8 # 6 /8<; 08! 8#! ! //#; /<88< / 8;8 /#/!!6 8/60 ##!08 #68< ;80/ 60 6; <AB6:8

8/! 88 ;1< <1 # ;</ <8 6 /6 # ! 1 ! /8< // 86 1 ! ;/ 8 < 8;8 / 0/ ;58A

/!108# #;18 /6#0<# 6/8!8 1/8< /;/!/6 1 818 ;1/!8 1;;8 /;#8< /<8 < #6 8!6 1/0<# 0 0 </<! /!/118 066 /# !0/ 1;60 /!/##/ /<806 /!0!1

<;8 0! </; 8<6 /8 0/# ;;0 /8/ /8#/ 8<; / # ! ! /# 8/1 1 8 ;0! 8# 8</ ;/ #0

!.!! /.;; !.;; !.;; !./8 !.#6 !.;! !.88 /. 6 /.11 !.!6 !.</ !.!! !./8 !.#/ !.8< !. ! !.8! !. ! !.8# !.88 !. 1 !.;< /.#6 !.#6

;;;;# 16< :;6566A C;B:

This table shows +arious blood bank scattered in India> it shows only !.#6= of people donating blood +oluntary or getting it replaced are affected with -I./AIDS. This clearly indicate that blood bank does not screen he blood.

29

OTHER OR'ANISATION >HICH HAS >OR=ED OR THE *REVENTION O AIDS.

30

Vari"u% %te&% taDe! 1y NACO t" &reve!t a!# "verc"me AIDS .

The first pro,ect was carried out fromC /008"/000 $hase @I The second pro,ect is running right nowC /000"8!!; $hase "II

O1Eective% ") *r"Eect.

1. To reduce the spread of -I. infection in India> 2. Strengthen IndiaEs capacity to respond to -I./AIDS on a long term basis

:<<82 :<<< *$a%e I

NACO *$a%e I 3:<<82<<4

The &ational AIDS 'ontrol $ro,ects was the first pro,ect in India to de+elop a national public health programme in -I./AIDS pre+ention and control, and was implemented between /008 and /000.

31

The ultimate ob,ecti+e of the pro,ect was to slow the spread of -I. to reduce future morbidity, mortality, and the impact of AIDS by initiating a ma,or effort in the pre+ention of -I. transmission. It constituted a start"up in+estment to launch e3panded pre+enti+e acti+ities. The specific ob,ecti+es were toC In+ol+e all States and 5nion Territories in de+eloping -I./AIDS pre+enti+e acti+ities with a special focus on the ma,or epicenters of the epidemic> Attain a satisfactory le+el of public awareness on -I. transmission and pre+ention> De+elop health promotion inter+entions among risk beha+ior groups> Screen all blood units collected for blood transfusions> Decrease the practice of professional blood donations> De+elop skills in clinical management, health education and counseling, and psycho"social support to -I. positi+e persons, AIDS patients and their associates> Strengthen the control of Se3ually Transmitted Diseases )STD*> 2onitor the de+elopment of the -I./AIDS epidemic in the country.

32

NACO *$a%e II 3:<<<2866B4 The $hase II of the &ational AIDS 'ontrol $rogramme has become effecti+e from 0th &o+ember /000. It is a /!!= 'entrally sponsored scheme implemented in # States/5Ts and 2unicipal 'orporations namely Ahmedabad, 'hennai and

2umbai through AIDS 'ontrol Societies.

T$e Nati"!a- AIDS C"!tr"- *r"Eect7 *$a%e II i% aime# at:

/. To shift the focus from raising awareness to changing beha+iour through inter+entions. 8. To support decentralization of ser+ice deli+ery to the States and 2unicipalities and a new facilitating role for &ational AIDS 'ontrol (rganisation. 3. To protect human right by encouraging +oluntary counseling and testing and discouraging mandatory testing> 4. To support structured and e+idence"based annual re+iews and ongoing operational research> #. To encourage management reforms, such as better"managed State le+el AIDS 'ontrol Societies and impro+ed drug and e%uipment procurement practices.

33

T$e &r"Eect ?"u-# %eeD t" ac$ieve t$e )"--"?i!( 1y t$e e!# ") t$e &r"Eect:

1. To keep -I. pre+alence rate below #= of adult population in 2aharashtra, below = in Andhra $radesh, Karnataka, 2anipur, Tamil &adu where the

-I. pre+alence is moderate and below /= in remaining states, where the epidemic is still at a nascent stage> 2. To reduce blood borne transmission of -I. to less than /= 3. To attain awareness le+el of not less than 0!= among the youth and others in the reproducti+e age group> 4. To achie+e condom use of not less than 0!= among high"risk categories like 'ommercial Se3 7orkers.

34

Re%u-t ") t$e Re%earc$.

35

G* 7hat is wrong in using condomsP

It reduces pleasure.

It is something une3citing.

If you use condom you doesnBt en,oy se3 because it reduces skin to skin closeness.

It is a useless thing.

It is boring.

It spreads disease.

These points show that the T.A. has negati+e perception towards using condom. 7hich means they ha+e a poor knowledge about the product and itEs uses and benefits. So besides educating them about -I. some education should also be gi+en to them towards using condoms.

36

/. Do you belie+e that e+en one unprotected se3 can lead to AIDS.

Unprotected Sex

No idea 28% Yes 56%

No 16%

Yes

No

No idea

-ere the ma,ority #6= has said yes but that is only in the case of prostitute. 9ew of the reasons which they ha+e gi+en areC

/* 'ertain particle passes from the prostitute to you. 8* The blood of the prostitute passes from her to the mate.

/6= of people ha+e said no because if you go only once the disease wonEt attack you. If you go regularly only then thereEs a chance of getting infected, it also depends on your destiny.

Femaining 81= is fully unaware of the fact.

37

=EY *OINTS / MYTHS >HICH CAME OUT ROM RESERCH.

38

=ey *"i!t% / Myt$%

9eel weak and e3hausted if I use condom.

Satisfied and safe if I use condom.

I doesnBt go to prostitute because it causes disease +iz.C itching

(ur society is such that we feel shy to buy a condom. There is lack of openness.

I donBt know where to buy condom.

4upt rog is that disease which cannot be detected.

&irodh is harmful for women.

If itBs in my destiny I will ha+e AIDS.

39

It is necessary to wash your pri+ate areas after se3 otherwise you are prone to a disease which I donBt know.

A medicine should be made to stop the erection of menBs pri+ate area.

-esitation and discomfort among many adults when it comes to discuss AIDS among themsel+es or doctors.

2a,ority of people belie+e that e+en one unprotected se3 can lead to AIDS, they know that condom can safeguard them from this disease still they donBt buy it.

5sing of condom is seen as a hindrance to se3ual pleasure.

AIDS spread due to the transfer of heat from the prostitute to the partner with whom she is ha+ing se3.

If I go to a prostitute who charges more money then usual than, I wonEt ha+e the disease.

I )T.A.* ne+er use condom with my wife.

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SU''ESTIONS 'IVEN ON THE +ASIS O RESEARCH.

41

Su((e%ti"! / Strate(y:
'ondom should be e3posed to remote areas.

'ondom should be distributed free of cost through functionaries working in hospital/clinics in these +illages

'ondom should be gi+en to the thekhadarBs or the sardarBs of these people so that they can tell their workers about the use of condom

If you need a blood transfusion, try to ensure that screened blood is used.

7hene+er you need a needle or syringe make sure the needle and syringe come straight from a sterile package or ha+e been sterilized properly> a needle and syringe that has been cleaned and then boiled for 8! minutes is ready for reuse.

Nou can a+oid -I. infection by abstaining from se3, by ha+ing a mutually faithful monogamous relationship with an uninfected partner or by practicing safer se3.

Impro+e the access of girls to formal schooling. Ansure they ha+e information about their own bodies, education about AIDS and the other STDs, and the skills to say no to unwanted or unsafe se3.

42

Ansure that girls and women ha+e access to appropriate health care and -I./STD pre+ention ser+ices at places and times that are con+enient for them. A3pand +oluntary -I. testing and counseling ser+ices. 2ake condoms and STD care a+ailable where women can go without embarrassment.

The male condom, currently the only barrier method a+ailable for -I. pre+ention, urgently needs to be complemented by methods that women themsel+es can use, if necessary without the knowledge or co"operation of their male partner.

Noung children should be educated for the disease. This can be done by moti+ating people to open up.

Show condom as something that gi+es lot more control, freedom, and satisfaction.

'onducting awareness programs geared towards youth and college students> and organizing 9amily -ealth Awareness 'ampaigns on a regular basis to

43

generate awareness and pro+ide ser+ice deli+ery for control of ST5 and FTI infections. To create awareness about the danger of multipartner se3 and how -I. spread through such beha+ior.

2ultiply and strengthen e3isting training opportunities for women, credit programmes, sa+ing schemes and womenEs co"operati+es, and link them with AIDS pre+ention acti+ities.

$romote AIDS awareness program on radio in the e+ening as much of the T.A listen to radio.

There should be one to one counseling sessions for T.A or they should be told about this disease in group at +arious tea shops and ,huggies.

$ro+iding +oluntary testing and counseling. This in+ol+es )i* increasing a+ailability of and demand for +oluntary testing, especially doing testing of couples )ii* training grass root le+el health care workers in -I./AIDS counseling> )iii* pro+iding counseling ser+ices through all blood banks in India and through STI clinics.

44

'onducting mass media campaign at the state and municipal le+el. This can be done by using traditional media such as folk arts and street theater in +illages.

$ro+iding counseling ser+ices at all the blood banks in India. )on how AIDS get transferred through blood transfusion*

0IMITATIONS.

The ma,or limitation of the study is the sample size. The sample size that I ha+e taken !. This may not gi+e true picture of the situation as it is.

The area of the sur+ey was restricted to places in and around Delhi only.

Time was also a constraint for the research as the presentations for the pitch was to be gi+en.

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-IST(FN (9 AIDS AIDS is a new disease and some of the key dotes in the disco+ery of the disease and isolation of the +irus are Summarised below C" $re /01! Silent $eriod C -i+ being transmitted before AIDS was recognised as new disease. Apidemic of $neumocystis corini infection in :os Angeles, 5SA :<C: E&i#emic ") =a&"%iF% %arc"ma i! Ne? Y"rD7 USA /018 'ase definition produced for AIDS by centre for Disease 'ontrol, Atlanta Slim disease encountered in Fakai, 5ganda I!crea%e i! =a&"%iF% Sarc"ma )"u!# i! 0u%aDa7 Gam1ia /01 Isolation of +irus by :uc 2ontagnier in 9rance

/01# Alisa blood test de+eloped /016 Dr. -alfdan 2ahler, then Director of world -ealth (rganization, address 5nited n on AIDS /01< 7ho special programme on AIDS formed )becoming a 4lobal programme on AIDS in /011* -I."8 +irus found in AIDS patients in 7est Africa. 9irst global meeting of heath minister on AIDS 9irst conference on AIDS in Asia and the $acific held in 'anberra, Australia

THE +IOCHEMICA0 STRUCTURE O HIV Alectron microscopy re+eals -I. to be a roughly spherical particle with a diameter of //! nm. The +irus contains a dark come shaped core measuring /!! nm in length with a width of #!nm tapering to ;! nm. 'loser e3amination of the particle )9igure /./* has shown that the surface of -I. is co+ered in a lipid bilayer from which <8 knob like structures are pro,ected. These pro,ections are composed of multimers of two +iral glycoproteins called gp/8! and gp;/. 4p/8! and gp;/ are deri+ed from a single precursor protein )gp/6!* enclosed by the -I. en+ gene. 4p;/ is a transmembrane glycoprotein that is anchored in the

lipid bailayer surrounding the +irus. 4p/8! is linked to gp;/ and is displayed at the surface of the +irus where it is perfectly located for its function of binding the +irus to cells carrying the appropriate cell surface receptors. The shape and integrity of an -I. +irion is pro+ided by the protein products to the gag polyprotein gene. The +iral matri3 is composed of the p/< 4ag protein and is attached to the inner face of the lipid bilayer. A second 4ag protein called p8; generates the characteristic come shaped core prominent in electron micrographs. A further two 4ag gene products known as the p0 and p6 nucleocapsid proteins are located within the core where they are closely associated with the +iral F&A genomes. The core contains all of the genetic and biochemical information re%uired for replicating -I.. This information includes two identical copies of the -I. F&A genome, a cellular transfer F&A )tF&A* captured during the budding process and three +irally encoded enzymes called re+erse transcriptase )FT*, integrase )I&* and protease )$F*. $rotein 4A( Table " $roteins of -I."/ Size )kDa* 9unction p8; 'apsid protein p/< 2atri3 protein p0 &ucleocapsid p6 p#/ Fe+erse transcription p66 Fnase - acti+ity p// 2aturation of +iral proteins p 8 .iral D&A integration into host genome 4p/8! Surface receptor 4p;/ 2embrane anchor P.iral / host fusion $/; Transacti+ation of +iral transcription p/6 Fegulation of +iral mF&A e3pression p8< Down regulation of host cell 'D; p/# Degradation of 'D; p/1 P .iral maturation factor p8 Fegulation of +iral infecticity p86 Tat and Fe+ function

46

$(: $rotease Integrase An+elope Tat Fe+ &ef .pu .pr .if Te+

THE 'ENETIC STRUCTURE O HIV A+ery -I. particle contains two identical stands of F&A, and each one of these F&A strands contains the entire genetic blueprint coding for the structure and life cycle of -I.. The -I. genome )9igure /.8* is made up of only 01!! nucleotides and is appro3imately /!! !!! times smaller than the human genome. Despite its relati+ely small size the -I. genome is a remarkable comple3 structure which encodes at least /< different proteins )Table /./*. In addition to

the genes encoding the 4ag, $ol and An+ polyproteins common to all retro+iruses, the -I. genome also carries open reading frames )(F9s* for se+eral regulatory proteins. The transacti+ator )Tat* and regulator of +irion e3pression )Fe+* play critical roles in the -I. life cycle and are essential for replication. ?y contrast, +iral protein F ).pr*, +iral protein 5 ).pu*, +iral infecti+ity factor ).if* and the so"called negati+e factor )&ef* are often described as Qnon"essentialB or Qaccessory proteinsB of -I. although it is clear that important functions may not be apparent during growth in +itro. At each end of the -I. genome is an identical se%uence called the long terminal repeat ):TF*. The :TFs contain regions that play a critical role in the process of re+erse transcription. 9urthermore, the #B :TF acts as the promoter for transcription of +iral messenger F&A )mF&A*. THE RE*0ICATION CYC0E O HIV ATTACHMENT The life cycle of -I. re%uires infection of a human cell. The preferred mechanism of entry of -I. into cells begins with recognition of a cell surface receptor called 'D; by the +iral surface glycoprotein gp/8!. This e3plains the marked preference of -I. for 'D;D T lymphocytes and macrophages. 'D; is a ## kDa glycoprotein that is structurally related to the immunoglobulin family of proteins. It consists of four immunoglobulinlike domain of 'D; )D/,D8, D and D;*, a membrane spanning region and short cytoplasmic tail. The amino terminal immunoglobulinlike domain of 'D; )D/* is composed of three loops known as the complementarity determining regions 'DF/, 8 and . .irus binding studies show that amino acids ;!"6! in the 'DF8 domain interact with a small pocket of ; amino acids located in the carbo3y" terminal end of gp/8!. Although discrete binding sites can be mapped on both 'D; and gp/8!, the molecular interaction re%uires the two proteins to be glycosylated and folded into their authentic three"dimensional conformations. These obser+ations suggest that gp/8! binding to 'D; is comple3 and probably in+ol+es contacts at secondary site such as the 'DF/ and regions of 'D;. 95SI(& A&D A&TFN ?inding of gp /8! to 'D; appears to be insufficient for mediating +iral entry, suggestion the in+ol+ement of accessory cell surface receptors. Indirect e+idence cells, albeit at a significantly reduced efficiency than that obser+ed with 'D;D cells. It is possible that gp;/ intersects with a Rfusion receptorS present on both classes of cells. Fecognition of 'D; by gp/8! probably enhances attachments of the +irus to the cell surface marking the fusion process more efficient. FA.AFSA TFA&S'FI$TI(& All retro+iruses must re+erse what is generally concei+ed to be be the normal flow of gnetic inforamtion that is D&A to F&A to protein. 9or -I. to utilize the F&A and protein synthesis machinery of the host cell it must first co+ert its F&A genome to a double @ standed D&A format. This is achie+ed in the cell cytoplasm by the action of the +iral enzyme re+erse transcripts )FT*

47

which catalyses a series of reactions.FT closely associated with the +iral F&A within the core structure and is acti+ated shortly after the core enter the cell following fusion. Fe+erse transcription is initiated at the #B, end of the single @ standard F&A genome. Initiation re%uires a host cell molecule called transfer F&A )Trna* which acts as the primer )or initiator* of D&A synthesize. An F&A depends D&A polymerase acti+ity of FT uses the primer to synthesize a D&A copy of the #B 5# and F region of the genome. A second acti+ity of FT, known as Fnase -, then remo+es the F&A copied by the polymers enabling the short D&A copy to from a new primer @ template pairing with the F region at the B end of the F&A genome. The F&A @ depends D&A polymerase acti+ity then complete synthesis of the )"* D&A strand. 7hile this take place F &ase - remo+es the rest to the F&A and creates a new primer for Synthesis of the )D* strand using the 5 and F region of the )"* strand as template. A D&A @ depent D&A polymers acti+ity of FT complete the process by copying to the B end of the )"* strand and ,umping o+erB to its #B end recognition of the #B primer bindings site. The end products of re+erse transcription is a double @ stranded D&A -I. genome containing all of the information originally held on the F&A genome.

48