HIV/AIDS in India

India has had a sharp decrease in the estimated number of HIV International Medical Commission on Bhopal
infections, from 2005 reports saying 5.2 million to 5.7 million had HIV to
2007 UNAids reports saying that number is now between 2 million and 3
Background
million.This brings the HIV prevalence rate in India below many western
nations including the US, Canada, Italy, France, and Spain, at .36
percent. The immediate scientific and medical response to the 1984 Bhopal
disaster constituted an extraordinary pulling together of hospitals,
medical personnel and social services in the area. Coping with a disaster
India's national epidemic is made up of a number of local epidemics, and
of this scale was unheard of anywhere in the world, and there was
in some places they occur within the same state. The epidemics vary,
widespread admiration for those who responded, often risking their own
from states with mainly heterosexual transmission of HIV (85%), often
lives in the process.
via interaction with sex workers, to some states where intravenous drug
use is the main route of transmission. Both tracking the epidemic and
implementing effective programmes poses a serious challenge to the However when the long term after effects of this disaster began to appear,
authorities and communities in India. HIV surveillance in India falls it was obvious that the social, political, and legal climate was inadequate
under the auspices of the National AIDS Control Organization (NACO). since there was little experience in dealing with a major environmental
The majority of HIV surveillance data collected by NACO is done through release.[1] Scientific and medical personnel needed access to accident-
annual unlinked anonymous testing of prenatal clinic (or antenatal related and toxicologic information to understand the causes and
clinics) and sexually transmitted infection clinic attendees. Annual potential consequences of the disaster. Union Carbide, the primary
reports of HIV surveillance are freely available on NACO's website. repository of this information, faced with lawsuits and the prospect of
bankruptcy, closed down its channels of communication. On the other
hand, the extreme sensitivities of the local and national government
India has a large population and population density, low literacy levels
bodies towards all aspects of the disaster, coupled with the lack of
and consequently low levels of awareness, and HIV/AIDS is one of the
expertise and funds, resulted in an inadequate response on India’s part
most challenging public health problems ever faced by the country. A
to meet the urgent health care and social recovery needs of the
recent study published in the British medical journal "The Lancet" in
community. Whereas local health professionals and the interested
(2006) reported an approximately 30% decline in HIV infections among
scientific community abroad expected a flood of information from a
young women aged 15 to 24 years attending prenatal clinics in selected
disaster of this magnitude, only a trickle resulted.
southern states of India from 2000 to 2004 where the epidemic is
thought to be concentrated. The authors cautiously attribute observed
declines to increased condom use by men who visit commercial sex These transnational political and legal ramifications threw a veil of
workers and cite several pieces of External links secrecy around the disaster and obstructed the discovery of vital medical
and toxicologic information. The medical community was often frustrated
in its attempts to understand the links between gas exposure and health
• National AIDS Control Organization and devise appropriate treatment strategies. As an example, ignorance
• - Working to make India AIDS FREE Any type of adolescent and about whether the main poison, methyl isocyanate, could decompose to
youth problems likemental Stress, umhappiness, typical youth deadly cyanide gas, led to years of acrimonious debate on the merits of
problems, teenage problems,which you can not discuss with treating the gas victims for cyanide poisoning.[2]
your family members even with close friends,there is a solution.
You can ask our counsellors to get a professional advice in this Recognizing the dire need of the gas victims, the Permanent Peoples’
regard. Ultimate vision of our is to have Healthy youth and Tribunal met in 1992 and recommended that an international medical
responsible Youth...Healthy India .... ....Developed India commission provide an in-depth independent assessment of the situation

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in Bhopal. The International Medical Commission on Bhopal (IMCB) was The commissioners divided their work in various groups:
thus constituted with 14 professionals from 12 countries who were
chosen on the basis of their medical expertise and experience in
environmental health, toxicology, neurology, immunology, and • Community & clinical studies: survey of the population followed
respiratory medicine. Drs. Rosalie Bertell and Gianni Tognoni served as by clinical testing of selected groups
the co-chairpersons of the IMCB. At the request of Carbide gas victim • Assessment of availability and quality of medical care, including
organizations, the IMCB conducted a humanitarian visit to India in level of medical resources available.
January 1994 to contribute in any way possible to the relief of the
victims and to suggest ways to in which such catastrophic accidents
• Examination of the adequacy and equity of laws and regulations
could be prevented in the future or their effects mitigated. During their relating to claims and the distribution of compensation;
stay, the IMCB met with government officials, various disaster experts, • Evaluation of drug therapy by examination of prescriptions
hospitals, research teams, local private physicians, biochemists, routinely given to survivors;
botanists, various survivor groups, environmental activists and • Accident analysis;
veterinarians.
• Review of studies and published literature on the disaster.

Goals
The IMCB had committed itself to a) provide a full report of its findings
and recommendations to the Governments of India and Madhya Pradesh,
The main goals of the IMCB were: victims’ organizations, and all other interested parties; b) stand ready to
assist the government of India and medical colleagues to implement the
1. Betterment of the lives of the victims with rational diagnostic recommendations of the commission; c) enlist the National Advisory
methods and treatment Committee to follow up the initiatives of the commission; d) recommend
2. Clarification of the place and form of international medical research studies to be undertaken in India on the long-term effects of the
assistance and documentation after a catastrophic accident gas exposure, and e) assure the wide circulation of its experience and
3. Recommending legislation to protect humans from military and findings in the professional literature.
industrial pollution
4. Mobilization of international assistance in response to the ] Findings
request of survivors rather than waiting for government
invitation.
5. Provide guidelines for planning health research on the impact of ] Union Carbide
major accidents
6. Establishment of a precedent for international protection for The IMCB publicly condemned Union Carbide and reiterated the
medical research against interference from vested interests or company’s full liability not only for responsibility in causing the deadly
corporations or governments gas leak, but also for the confounding role of its behavior with respect to
7. Legitimization of the voices of survivor organizations and their pre-accident preventive and exposure mitigating efforts, and the timely
participation in relevant decisions and effective application of the appropriate medical measures at the time
of the accident. This included the lack of transparency about the
8. Promoting ethical and scientific standards for information
composition of the gases released, resulting in the absence of rational
collection and communication to victims methods of care and planning resulting in loss of sight and in some cases
9. Coordination of medical, research, and legal information to life, and creation of suspicion and conflict among professionals and the
assist victims in claims population. There was also a lack of emergency preparation which would
10. Alerting the Government of India to the need for full disclosure have made the public and professionals aware of the potential toxins
of potential hazards and environmental impact studies prior to inside the plant and how to respond to an accident.
allowing any hazardous industry to set up in India

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[edit] Indian government It is now well known that persistent and chronic gas-related health
effects are present in the Bhopal population.[3][4][5] However, the full
spectrum of effects is yet to be defined, especially in those exposed as
The government of India also was faulted since no clear guidelines were
children or in utero, and as manifested in survivor reproductive
laid down to determine compensation to the victims resulting in undue
health.[6][7] There has been a lack of systematic collection of relevant
delays and aggravation of their health status and/or economic survival.
information in these reproductive effects, and also with respect to cancer
The secrecy surrounding the health studies undertaken by the Indian
development or other chronic illnesses as sequelae of the gas exposure.
Council of Medical Research may initially have been instituted to protect
the litigation process, but in reality made the rational medical treatment
and establishment of claims almost impossible. In hindsight, it is clear Recent investigations have shown that local well water has become
that the secrecy served no purpose whatsoever and has resulted in non- contaminated by the improper storage of a large amount of hazardous
publication of the information. Moreover, because of the secrecy about waste in the facility, or on its grounds.[8] This toxic waste is especially
the accident itself and the chemicals released, it was difficult for the hazardous to those still suffering the effects of direct exposure to the gas.
survivors to document their claims. The Commission also noted an
excessive fear among government personnel of bogus claims.
As of 2007, the prospects for learning the sequelae of this disaster do not
appear to be bright. What is sorely needed is an independent body to
In fulfilling its commitment, results of the community studies coordinate the heath care, research, rehabilitation of gas victims, and
conducted by the IMCB have been communicated to the affected care for potential effects in their offspring. Instead of the non-directive
population in the form of public meetings, which provided a forum symptomatic medical treatment that currently exists, clear guidelines
for the victims to ask questions and provide comments. The studies and criteria need to be formulated for specific medical conditions such as
have also been published in various national and international damage to broncial tubes, sleep apnea, neuron destruction, etc. . Such
journals so that the scientific Recommendations of the IMCB an effort could be implemented through India's existing heath care
pyramid. Community-level health units should be developed to serve a
maximum of 5000 people each. Local hospitals with multiple
The IMCB made the following recommendations:
departments can be used to provide secondary care. A specialized
medical center dedicated to treatment and research of the more serious
1. Reorganization of the health system to establish a network of problems arising from the gas leak should be established.[9]
community-based primary care clinics; 2. The gas-related disease
categories need to be broadened to include central nervous system and
The IMCB believes it is a mistake to simply increase the number of
psychological (PTD) injury; 3. A conference to determine best practice
hospital beds in Bhopal. The community has need for more
rehabilitation medicine, including both Western and Indian expertise,
neighborhood clinics, non-drug respiratory therapy, clean air and water,
must be undertaken to develop rational treatments and prescription
and sheltered workshops, not for more hospital beds.
drugs for survivors. 3. Health data collected by the ICMB should be
communicated to the population and submitted for publication in
professional journals. 4. Gas victims to have the right of access to their Need for long-term monitoring
medical records; 5. Victim organizations should be adequately
represented in the national and state commissions dealing with the
The IMCB has recommended that long-term monitoring of the
disaster; 6. Criteria for compensation should include medical, economic
community for illness and response to treatment be done for several
and social damage to the victims 7. Allocation of resources for economic
decades. This would include the study of exposed and unexposed areas
and social rehabilitation of people and their communities should be
to observe patterns of illness and death as well as to detect the
made. 8. Thorough examination of the impact of the toxic waste buried
occurrence of related chronic diseases and the appearance of new
on the Union Carbide site and its potential for further damage to public
diseases. Such an approach needs to be one in which the health
health needs to be researched.
professionals involve the community of gas victims as active partners in
investigation, provide them with feedback on community health, ensure
Long-term effects that their health risks are properly communicated, and thereby enabling

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an increase in their consciousness, autonomy and self- Working with
other agencies

Recognizing that Bhopal is a tragic model of an industrial epidemic, the

IMCB has expressed willingness to organize international teams when
requested, to provide technical assistance and evaluation of other
environmental disasters. Rather than the provision of emergency relief
functions, for which there are other organizations such as Medecins sans
Frontieres and the Red Cross/Red Crescent, the IMCB envisions its role
at three levels:

1. response to communities who appeal on the basis of chronic

disability due to a disaster, after its acute phase is over;
2. represent victims at the international level, for example, the
World Health Agency, to recommend legislative changes
required to implement the International Bill of Rights relevant
to health and safety, and
3. working to define the appropriate public health investigations to
serve the needs of the injured community rather than use the
victim community to merely serve the needs of science.

The International Bill of Rights includes: The Universal Declaration of

Human Rights, proclaimed on Dec 10, 1948; The International Covenant
on Economic, Social, and Cultural Rights (1976), and the International
Covenant on Civil and Political Rights, 1976.

The steps to be taken to achieve the full realization of this right shall
include: - provision for the reduction of infant deaths and for healthy
development of the child; - improvement of all aspects of environmental
and industrial hygiene; - prevention, treatment, and control of epidemic,
endemic, occupational and other diseases; - creation of conditions which
would assure to all people medical service and medical attention in the
event of sickness, - assuring the victims a living, work and social
environment conducive to healing of its injuries.

To protect these rights, an international body, free of industry and

government pressures, and competent to advise on health and safety
standards, is required to be able to mediate just and equitable resolution
and compensation of damage in the case of unanticipated disasters