HIV/AIDS Nursing Clinics in India

India is second in the world to China as having the most populous nation and second in the world to Africa for cases of HIV and AIDS. This large number of cases is likely because of two main causes: males frequenting female sex partners in large cities and intravenous drug use. For nurses travelling to India many aspects need to be considered, including; demographics, education programs, interaction with nurses, ethical and political issues, other frequent medical problems, and personal interaction with nursing staff to work to stem the spread of HIV and AIDS. 

The AIDS epidemic in India is prevalent in the nation which has two million HIV-infected people with female sex workers and male clients of female sex workers with a substantially higher rates of HIV prevalence than in the general population (Raj, et. al, 2011, p.1374). The reason for this statistic is likely the “inconsistent and non-condom use,” “behavioral issues such as alcohol,” and “attitudinal factors” (Raj, et. al, 2011, p.1374). However, the AIDS awareness group AVERT states that overall, the country has a low rate of infection but specific areas, such as; Manipur, Andhra, Pradesh, Mizoram, Nagaland, Karnataka, and Maharashtra have epidemic level statistics. As for causes of the HIV spread the AVERT website suggests, “Infections in the north-east are mainly found amongst injecting drug users (IDUs) and sex workers” , but the disease is linked to other environmental factors as well (2008). The demographics show that the largest growing group is heterosexual men who have engaged in unprotected sex with a sex worker.

The 2011 statistic is the demographics of HIV infection is largely men ages 15-49 at .36% with the highest prevalence being men between the ages of 30-34 (Raj, et. al, p.1374). In a 2001 article, researchers found that the reason for this spread was the line haul truck routes, with men in their early 30’s frequenting heterosexual sex workers along the truck routes. Multiple unprotected partners means that the epidemic continued to grow exponentially throughout the truck stops and routes (Venkataramana, et. al, p.1040). The demographics can be used to understand the plan of action that medical care professionals need to take when approaching patients and offering care.

When deciding the plan of action for developing a community HIV clinic in India, one important consideration is whether the spread of HIV in the area is due to injecting drug users (IDUs) or sex workers since the largest demographic could be addressed first to stop the immediate spread and the smaller demographic can be addressed to help decrease the overall numbers of HIV cases (Rodrigues, R. J., Antony, J., Krishnamurthy, S., Shet, A., & De Costa, A. 2013, p.2). Since the information is that sex workers and their patrons are the largest growing number, proving education and condoms to sex workers may be the first action to take. 

There are several other medical issues to consider; drug resistant tuberculosis, acute respiratory infections relating to pollution, ocular inflammatory disease, inadequate clean drinking water, sanitation issues, and malaria (Rao, 2012, p.18). Several infection related illnesses such as tuberculosis and respiratory infections can compound issues for patients with HIV/AIDS and can cause complications or death. 

Access to medical care has been improving since the implementation of the 2002 National Health Policy which seeks to increase the availability and coverage of private medical care for all but especially focusing on those living in poverty (Rao, 2012, p.20). This policy encouraged private investments to establish a network of doctors and care across the country. The government of India also offers support by reducing utility charges, free or discounted land, and low interest loans for medical facilities (Rao, 2012, p.16). The same article by Rao also discusses some of the problems with the policy, in which the competency of the medical staff may not be strong enough to face some medical conditions, especially in children and respiratory infections. Rao also discusses the issue of inequality of access to care for women and those in rural areas (2012, p.30). 

In preparation for a work assignment in India I would ensure that I was well-versed in national and local etiquette. For example, modesty in dress is important, not wearing shoes indoors (other than medical care facilities), not pointing feet at people, not eating food or passing objects with the left hand are common things an individual may do without realizing the accidental rudeness to patients, nurses, or doctors. Some other considerations, such as a smaller social “bubble” and inquisitive personal questions have been noted by travelers as being uncomfortable by American cultural standards. When interacting with patients and working to gain their respect and confidence, it is important to know what to do to maintain good relationships with patients. 

For nurses travelling to India immunizations should be thorough as it is likely that the location will be outside of the areas that tourists visit and there is a higher chance of diseases. The Centers for Disease Control’s website (2011) suggests that all routine vaccines, including an updated tetanus vaccine, Hepatitis A, Polio, Meningococcal, Typhoid, Hepatitis B, malaria, rabies (if suggested based on area), and Japanese encephalitis if a stay longer than a month is required. Constant interaction with people who are ill means that immunizations can mean all the difference to the health of the nursing staff. Prophylaxis medication that should be taken and includes Lariam, Malorona, or doxycycline to ensure that I do not contract malaria from the mosquitos. 

Interacting with Indian nurses means being culturally sensitive but also being aware of the knowledge gaps that the nurses may have. In a 2011 article in The Lancet, the author brings up a very important problem in the fight against infectious diseases in India: the doctors and staff are often not trained well enough in HIV/AIDS prevention and care (Chandrasekar, p.809). Rao (2012, p.18) also mentions this in his article as well, leading me to believe that this is a prevalent issue in clinics. Since it is the nurses who many times interface with the patients the most, I believe a review training would be positive so that nurses may be able to better care for patients who are coming in with infectious diseases. Since “infection […] is the leading cause of death in India,” (Chandrasekar, 2011, p.809) trainings on hand washing, sanitation of hospital tools, and overall sanitation may help reduce the number of infections. While the goal is to work in India to reduce the number of HIV/AIDS patients, reducing infections can improve care for immune suppressed individuals who already have HIV.

The ethical and political issues nurses in India may face is inequitable access to care and individuals who do not seek care because they do not have money. Since the evidence provided has shown that the epidemic level areas are city centers, community education and awareness that informs people about testing and services provided may encourage individuals to seek testing and care. There are organizations such as Avert that are currently working in the area and it would be beneficial to network with other workers to find out the political issues in the area. However, one of the most vital steps is to stop new cases by educating sex workers and offering condoms. While there are cultural issues with condoms, according to Raj, a community movement among the sex workers can drastically reduce the number of new cases. 

The AIDS/HIV epidemic in India has been a growing problem for the past twenty years and has been becoming a focus for international health groups, public and private. However, doctors, nurses, and community workers have been working to reduce the number of new cases and improve the care for patients who are already infected. Working with other established organizations and focusing on the specific demographic groups to stop the spread is another step in the right direction for India. 

References

"Avert: overview of HIV and AIDS in India." HIV & AIDS Information from AVERT.org. AVERT, n.d. Web. 11 July 2013. http://www.avert.org/aidsindia.htm.

Chandrasekar, Pranatharthi. Urgent need for training in infectious diseases in India. The Lancet Infectious Diseases, Volume 11, Issue 11, Pages 809 - 810, November 2011. doi:10.1016/S1473-3099(11)70300-0

"Health Information for Travelers to India -Travelers' Health." Centers for Disease Control and Prevention. N.p., n.d. Web. 11 July 2013. <http://wwwnc.cdc.gov/travel/destinations/

Raj, A., Saggurti, N. N., Cheng, D. M., Dasgupta, A., Bridden, C., Pradeshi, M., & Samet, J. H. (2011). Transactional sex risk and STI among HIV-infected female sex workers and HIV-infected male clients of FSWs in India. AIDS Care, 23(11), 1374-1381. doi:10.1080/09540121.2011.565034

Rao, P. H. (2012). The private health sector in India: A framework for improving the quality of care. ASCI Journal of Management, 41(2), 14-39.

Rodrigues, R. J., Antony, J., Krishnamurthy, S., Shet, A., & De Costa, A. (2013). ‘What do I know? Should I participate?’ Considerations on participation in HIV related research among HIV infected adults in Bangalore, South India. Plos ONE, 8(2), 1-8. doi:10.1371/journal.pone.0053054

Venkataramana, C. S., & Sarada, P. V. (2001). Extent and speed of spread of HIV infection in India through the commercial sex networks: a perspective. Tropical Medicine & International Health, 6(12), 1040-1061. doi:10.1046/j.1365-3156.2001.00814.x