Serodiscordant couples in India and HIV infection, New Book

New book provides insights into Serodiscordant couples in India and their lives with HIV/AIDS. Serodiscordant couples are those where only One partner is infected with HIV

Serodiscordant couples in India, is not a new thing. With more than thirty years since HIV was first detected in India and lack of public awareness about safe sexual conduct; an estimated 2.4 million or 24 lakh people in India are presently estimated to be living with HIV/AIDS and theoretically capable of spreading infection to their un-infected partners. If we imagine marriage in India an omnipresent institution then, most of these persons with HIV infections constitute Serodiscordant couples in India.

Although, it is quite difficult for an Indian to imagine someone marrying an HIV infected person willingly; but other countries do have such Serodiscordant couples, who knew the other person’s HIV infection before marriage; but still decide to enter into wedlock. But, Serodiscordant couples in India, are mainly a result of one partner getting infected while in marriage OR the person doesn’t have the knowledge of other person’s HIV status before marriage.

Serodiscordant couples in India and HIV infection
A new book named Three Decades of HIV/AIDS in Asia by Dr Jai P Narain (who has written a slew of books on other health topics) sheds more light on the existence of Serodiscordant couples in India and their lives with HIV/AIDS. Summarising his book the author says its now possible to imagine a healthy serodiscordant couples in India.

According to a study quoted in a new book on HIV/AIDS., the Transmission of HIV infection from infected to uninfected partner can be reduced by 92 per cent to 96 per cent by putting the patient on routine anti-retroviral treatment (ART)- the drug therapy routinely used to improve quality of life of HIV/AIDS patients. Contrary to the prevalent perception that HIV transmission from infected to uninfected partner is definite, the breakthrough can prove boon for such couples, which are termed as Serodiscordant couples.

The book Three Decades of HIV/AIDS in Asia’  quotes a number of studies, one among them is a multi-national study conducted in 13 sites in 9 countries of Latin America, Africa and Asia, including Pune and Chennai in India, which demonstrates the,  effectiveness in preventing HIV transmission in Serodiscordant couples, where one partner is HIV-infected and other is not.

The book is a compilation of research works of various health experts and addresses evolving nature of HIV/AIDS and its unprecedented health and development threats in Asian countries. Of 1763 such couples studied, the study showed that ART was 96 per cent effective in preventing HIV transmission to HIV-negative partners. These findings shows that ART can not only reduce death rate and improve the quality of life of HIV patients but also reduce the HIV transmission. The study quoted in the chapter titled “Emerging issues with HIV and TB Prevention” was conducted in various sites of Brazil, India, USA, Botswana, Kenya, Malawi, South Africa, Thailand and Zimbabwe.

Dr Jai P Narain has been associated with HIV and TB control programme of WHO since 1988. Dr Narain is currently working as Senior Advisor to Government of India on Epidemiology and also served as Director, Department of Communicable Diseases, WHO South-Asia Regional Office.

Dr Narain says drugs used in ART therapy prevent HIV transmission from infected to uninfected partner by lowering the count of HIV virus in the blood of infected partner.

Deriving from his near two decade experience at Top level, Mr. Narain says,

“In HIV, ART is expected to reduce the infection load or the viral load to such low levels that HIV infection cannot be passed on to the uninfected partner. In summary, this is an example of “treatment as prevention” or treatment acts as a prevention strategy”.

The book outlines a new approach, if successful, would prove a boon for countries like India, where 2.4 million people are presently estimated to be living with HIV/AIDS and theoretically capable of spreading infection to their un-infected partners, claims the author.

ART is Effective in reducing substantially the transmission of HIV:

Dr. Narain says that the risk of infection can be reduced substantially if infected individuals are diagnosed and treated with ART. The concept is now clear and well established that HIV treatment can also prevent [transmission of] HIV. Hence the ART  could be exploited maximally if more and more HIV patients diagnosed and put on ART therapy. the book thus gives a strategy to enhance the access to ARV drugs.

Another chapter lists the major challenges of the HIV/ AIDS in India – the Epidemic and the national response. The author says that the utilisation of ART depends on awareness of the value of testing and knowing one’s HIV status, and availability of drugs, infrastructure and staff. Stigma-associated discrimination is still a key factor in deciding access to testing and resultant linkage to treatment services among high-risk polpulations. A three-centre cohort study of patients initiated on ART in India reported that 16 per cent were lost to follow -up and 35 per cent missed their monthly appointments to pick up drugs.

The book which is a compendium of various research papers, contains chapter on country specific HIV related problems being faced by countries such as Bangladesh, Sri Lanka, where the disease has low prevalence rate and also from Combodia, China, India, Pakistan, Thailand and Vietnam, the countries facing very high HIV patient load.

The book also limns the natural history of HIV infection and addresses the burning issues of degree of HIV epidemic and intervention among sex workers, Injectible Drug Users (IDUs) and transgender population apart from dedicating exclusive chapters on prospectus if HIV vaccine development in Asia and implications and feasibility of commercial health insurance for HIV patients in India.