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What caused Uttar Pradesh’s HIV outbreak?

There may be more reasons behind Uttar Pradesh’s HIV outbreak in Unnao district than meets the eye. A quack doctor was held responsible after being accused of administering HIV contaminated injections to villagers. The case may continue for some time, however, state officials say they believe this man is not the sole cause of the recent outbreak.

At least 46 people have been infected with HIV in Bangarmau Tehsil of Unnao district in southern Uttar Pradesh within the last 10 months. A quack doctor, Rajendra Yadav, fell under suspicion. Yadav travelled to villages in the area administering medical treatments — reportedly for only ten rupees. He came to the attention of state officials when locals reported that he used a common syringe to treat several individuals.

It is required practice in many medical treatments to use disposable syringes. These should be safely disposed of following each use. Use of the same syringe can allow blood-borne pathogens to be passed between individuals — HIV often used to be transmitted in this manner.

The use of contaminated needles in such a manner is not an isolated incident. Mehtab Alam, a project manager for Raza Hussain Memorial Charitable Trust, says fake doctors will often not use disposable syringes. Instead many use a single glass syringe on multiple individuals, as Yadav is alleged to have used.

Yadav went on the run after he learnt of the police’s intention to arrest him, but was caught and arrested. He has been charged under Sections 269 (negligent act likely to spread infection of disease deadly to life) and 308 (culpable homicide) of the Indian Penal Code, as well as Section 15(3) of the Indian Medical Council Act.

Officials, however, believe that Yadav cannot be solely responsible for the outbreak. “We cannot overlook the fact that such fast spread of HIV infection over a year isn’t possible entirely due to use of a single infected [needle],” said NG Ravi Kumar, district magistrate of Unnao.

The district’s chief medical officer, SP Chowdhary, speculated that the village’s large population of migrant workers may have played a role in the outbreak of HIV cases. Of 58 HIV positive cases in the area, two admitted that they had paid for sex without using protection while away from the village for work.

This opens up the possibility that the quack doctor may have played only a partial or even minor role in the outbreak. Many workers in the Unnao district are in occupations such as truck drivers, and are frequently away for work. Though only two admitted to unprotected sex while away on work, there is the potential that more HIV positive individuals were infected in this manner.

The migrant worker explanation may even fit into the previous assumption that the quack doctor spread the disease through the community. If one of the migrant workers was infected and returned to the village, then received treatment from the quack, this could have propagated the virus through the community as the initial infected blood.

The migrant explanation stresses the need for sexual education and the availability of condoms, as unprotected sex is one of the most common transmission methods of HIV.

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