HIV epidemic in Mizoram, India: A rapid review to inform future responses

Abstract

Background & objectives: Mizoram, a northeastern State of India bordering Myanmar, is home to several tribal clans under the ethnic group Mizo: Renthelei , Ralte , Paite , Lai , Hmar , Lusei , Mara , Thado and Kuki . Mizos also reside in the neighbouring northeastern States of Tripura, Assam, Manipur and Nagaland. The majority of Mizo people outside India live across the border in the neighbouring Chin State and Sagaing Region of Myanmar. Over the last decade, Mizoram witnessed a concerning level of rise in HIV prevalence among the general population. The present rapid review was conducted to identify various interventions that could help curb this rising trend. Methods: An electronic search strategy with broad domains of ‘HIV/AIDS’, ‘key population’, ‘community engagement’ and ‘interventions in Mizoram’ using PubMed, Embase and Cochrane was adopted; grey literature were also accessed. Evidence, thus gleaned, were synthesized. Results: Twenty eight resource materials comprising articles, reports and dissertations contributed to the current review. Changing tribal social support structure, early initiation of drugs, sexual debut at an early age and drug–sex interface were identified as factors associated with the progression of HIV epidemic in the State. Issues pertaining to the migration of people across the borders and easy access to drugs continue to be of concern. Churches and youth leaders have a strong influence on the society, at times even constraining access of key population groups to HIV prevention and care services. Tackling stigma and discrimination, ensuring uninterrupted HIV services and creation of an enabling environment in this context seems urgently needed. Incarcerated people in the State have been found with a high level of HIV infection and their linkages with prevention and care services need strengthening. Interpretation & conclusions: This review underscores the importance of drawing upon successful intervention examples from the past such as ‘Friends on Friday’ and Red Ribbon Clubs. Active engagement of community-based organizations in programme planning, implementation and monitoring is essential. Establishment of harm reduction interventions for general and key populations paired with strategic communication appear to be the need of the hour.

Revolutionizing HIV-1 Viral Load Monitoring in India: The Potential of Dried Blood Spot Analysis for Expanding Access and Improving Care

“…Consequently, remote and hard-to-reach locations are underserved in terms of testing facilities. This situation poses challenges for PLHIV patients who may find it difficult to visit testing centers or face increased expenses and time constraints when transporting samples to distant viral load testing facilities [3,15]. Due to diverse geographical and social conditions in India, providing access to viral load testing facilities for specific population groups such as children, pregnant women, and other vulnerable individuals poses significant challenges.…”

Finding a way forward with the community: qualitative inquiry in the generalized HIV epidemic in Mizoram, India

“…Development of IDI guides and probes was informed by a rapid review of HIV situation in Mizoram (16) conducted by us, These tools were further refined through discussions among the research team members some of whom were from Mizoram. The following domains were identified; 'HIV situation in Mizoram' , 'vulnerability to HIV' , 'availability of health care services and access to them' , 'roles of organizations' , 'government supported targeted interventions (TI)' , 'HIV prevention' and 'ways suggested for improvement' .…”

A change long overdue

“…The main finding from the HIV surveillance from different rounds in India has been that overall, there has been a decline in prevalence nationally. However, this top-level finding masks the fact that prevalence has risen in several states, including a drastic increase in the prevalence of HIV in the State of Mizoram 5 . Furthermore, after two to three years of collecting and compiling data, local community groups involved in the survey could not even be given information about weaknesses in their interventions, missing a huge opportunity to empower them with local knowledge.…”