Health: HIV and AIDS (Prevention and Control) Act, MMR, Oxytocin, RTS Vaccine

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The Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act. A legal obligation to protect the privacy of persons with HIV and AIDS. India has the third largest HIV-infected population (estimated 2 million) .

  • To decrease new infections by 75 % between 2010 and 2020.
  • Eliminate AIDS by 2030.
  • India is also a signatory to the Declaration of Commitment on Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (2001) .
  • To secure a global commitment to enhancing coordination.
  • Intensification of national, regional and international efforts to combat it in a comprehensive manner.


  • Prohibition
  • Right to reside
  • Consent
  • Disclosure
  • Obligation
  • Enquiry
  • Restricting cameras in courtroom wherever required.

HIV Estimates-NACO

  • The National AIDS control organization.
  • Estimation process has used the data from two successive rounds of National Family Health Surveys (NFHS) .
  • To present the most accurate data sets for prevalence, incidence and mortality due to HIV/AIDS.
  • A progressive decline in India for the last 15 years.
  • New infections in 2017 - 87,000 a little more than what it was in 2015 - 86,000.
  • The prevalence levels-HIV infections have marginally increased to 21.40 lakh.
  • The mortality rates - Show the number of people who died of AIDS thereby showing a significant and consistent fall.


  • Inadequate funding/investments
  • Lack of engagement in the implementation of prevention programmes.
  • Lack of visibility.

Needs to be Done

  • To bring convergence with national TB control programme.
  • Commitment for elimination of TB by 2025.
  • Proper and effective governance model.
  • A focussed approach with greater involvement of community-based organisations and the private sector.
  • The incidence levels of HIV need to be brought down below the present levels in the next two to three years so as to bring the target of ending AIDS by 2030 could be realised.

The Dilemma with E-Cigarettes

  • Health effects of 3-cigarettes.
  • Ban on e-cigarettes in Delhi due to its likely health implications.
  • Already banned by Karnataka and Maharashtra.
  • The Union Health Ministry՚s stand against the ban.
  • E-Cigar which is a new technology are supposed to be better than the conventional cigarettes.

Health Implications of E-Cigars

  • Produce carcinogens such as formaldehyde at high temperatures.
  • Lung disease and myocardial infarction.

Way Ahead

  • A promising smoking cessation aid is likely ti be taken away by completely banning the e-cigarette technology.
  • Tight regulations of e-cigarettes.
  • Creating standards for the aerosols and banning underage and public use.
  • A therapeutic alternative for the smokers thereby protecting youngsters from a gateway drug.

Decline in MMR in India

  • Maternal Mortality Rate.
  • 22 % drop recorded.
  • The proportion of maternal deaths per 1,00, 000 live births.
  • The death of a woman while pregnant.
  • Obstetric risk- The risk associated with each pregnancy.
  • The death may also happen within 42 days of termination of pregnancy.

Causes of Death

  • Complications during pregnancy and childbirth.
  • Management issue.

Recent Findings

  • Decline in MMR from 167 in 2011 - 2013 to 130 in 2014 - 2016.
  • Most significant in Empowered Action Group (EAG) states.
  • EAG States- Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, UP and Uttarakhand.
  • In Assam there has been a registered decline from 246 to 188.
  • Southern States- Decline has been from 93 to 77 whereas for other states the decline is from 115 to 93.

Contribution of NRHM (National Rural Health Mission)

  • Janani Suraksha Yojna (JSY) - A conditional cash transfer scheme to motivate pregnant women for institutional deliveries.
  • Mother and Tracking System
  • Auxiliary nurse midwives (ANMs)
  • First referral units (FRUs)
  • The Accredited Social Health Activist (ASHA)
  • Janani Shishu Suraksha Karyakram (JSSK)


  • Lack of infrastructure.
  • Target of reducing MMR by 75 % from 437 in 1990 to 109 in 2015 through the millennium development goals missed.
  • Janani SurakshaYojna (JSY) is limited to women below poverty line up to first two childbirths.

Government Ban on Oxytocin

  • Restriction on the production and sale of oxytocin.
  • Used in injecting milch animals for eg cows to increase the milk production.
  • To increase the sizes, vegetables and fruits are injected with Oxytocin.
  • Also used in illegal and unsafe abortions to induce labour.
  • Illegal trade from China.
  • The unlicensed companies in India sold oxytocins in “crude plastic bottles” .

Concerns with the Ban

  • Supply shortages of the drug due to the restriction.
  • The KAPL exemption has paved the way for a PSU monopoly.
  • KAPL also claims to have the capacity to supply the country՚s requirement.
  • Little transparency over the drugs pricing in comparison to that of private producers.

Needs to be Done

  • Reconsideration of ban on private production.
  • Abuse needs to be curbed by restricting human and veterinary sale.

Multiple layers of documentation could be adopted:

  • Narcotic
  • Psychotropic drugs
  • Antibiotics
  • Implementation of massive surveillance and raids on illegal importers and unlicensed producers.

Formalin-A Banned Preservative

  • Fish laced with formalin.
  • Massive health impacts.
  • Ban on fish supplies by the Goa government.
  • Formalin is a banned preservative.
  • Border checks to inspect trucks for fish.

Formalin Detection and Contamination

  • Kerala became the first state where reports of formalin-laced fish came from.

Operation Sagar Rani of Kerala government:

  • A storm of raids.
  • Under its fish safety and hygiene campaign.
  • Seizure of about 9,600 kg of contaminated fish in Kollam district.
  • Seizure of about 6,000 Kg of fish in Palakkad district.
  • Andhra pradesh has been transporting cultured fish with sufficient quantity of ice for retarding degradation.
  • During the transportation process, the fish nevertheless tends to get spoilt.
  • To prevent spoilage Andhra Pradesh suppliers lace fish with formalin which retards degradation to more than 10 times its natural rate.

Illegal Use of Meldonium

  • The Anti-Doping Appeal Panel of the National Anti-Doping Agency (NADA) .
  • Two persons related to illegal supply of meldonium were banned.


  • Prescribed for ischemia is a condition in which there is an insufficient flow of blood to tissues.
  • Manufactured by the Latvian company Grindeks.
  • It gives more physical capacity and mental function to those suffering from heart and circulatory conditions.


  • A number of athletes have been caught using it as it adds oxygen uptake and endurance.
  • In September 2015, the World Anti-Doping Agency (WADA) put Meldonium and the same ban went into effect on January 1,2006.
  • Confirmation of meldonium in 55 samples by WADA.

Drug Testing and Analysis in 2015 concludes:

  • An Increase in Endurance Performance of Athletes

  • Protection against stress
  • Improved rehabilitation after exercise
  • Enhanced activations of central nervous system (CNS) functions

Case Relevance with India

  • A decathlete named Jagtar from Patiala was tested positive for Meldonium at the Federation cup in 2017.
  • The case revealed the discovery of a very important source of illegal/unlicensed supply of prohibited substance to athletes at the Jawaharlal Nehru Stadium, New Delhi.
  • NADA was directed to issue appropriate warning to be affixed on notice boards/websites of NADA regarding prohibited substances and the risk of procuring any supplies by the athletes from illegal suppliers.

Global Nutrition Report 2018

  • India facing a major malnutrition crisis.
  • Concerted actions to address the gaps and concerns.

Report Highlights

  • 150.8 million Children are stunted globally.
  • Nearly 50.5 million are wasted.
  • Two countries belong to Asia of the three countries that are home to almost half (47.2 %) of all stunted children. India is at the top followed by Nigeria and Pakistan.
  • In terms of wasting India accounted for 25.5 million children followed by Nigeria and Indonesia.
  • India has more than a million overweight children followed by China, Indonesia, Egypt, US, Brazil and Pakistan.
  • Urban areas have 7.1 % children on average whereas rural areas 6.2 % overweight children.
  • There exists more than one form of malnutrition in 88 % of countries.
  • Packaged foods-Only 21 % of packaged foods in India are rated as being healthy.

Case with India

  • Spatial Variation-As per the International Food Policy Research Institute (IFPRI) stunting variation was reported from district to district.
  • Out of 604 districts 239 have stunting levels above 40 % .


  • Gender
  • Education
  • Economic status
  • Health
  • Hygiene
  • Other demographic factors

Other Influential Gender-Related Factors Included

  • Maternal education (accounted for 12 %)
  • Age at time of marriage (7 %)
  • Antenatal care (6 %)
  • Children՚s diets (9 %)
  • Assets (7 %)
  • Open defecation (7 %)
  • Household size (5 %)

Needs to be Done

  • Immediate policy action to reduce inequalities and childhood stunting.
  • Targeted interventions for supplementary nutrition should be made.

Report on Child Care Institutions

  • Ministry of Women and Child Development.
  • Drawbacks have been analysed by a Central government committee.
  • Nearly 9,600 Child Care Institutions and Homes were studied run mostly by the NGOs.

Key Findings

  • As per JJ Act 2016 (Juvenile Justice) Only 32 % of Child Care Institutions or Homes were registered.
  • Total homes with Child Care Institutions- 32 % .
  • Showing signs of hunger or illness-Only 28 % .
  • Children living in without proper toilets and secure compounds.
  • No opportunity to address their grievances.

Needs to be Done

  • Emergency measures to bridge the gap in the institutions.
  • Systematic scrutiny by State governments.
  • To bring about uniformity of standards and procedures.
  • NGO՚s effort is of utmost importance.

Ten Threats to Global Health in 2019-WHO

Released by the World Health Organisation.


  • Air pollution, climate change
  • Non-communicable diseases
  • Global influenza pandemic
  • Fragile, vulnerable settings
  • Antimicrobial resistance
  • Primary healthcare
  • Vaccine hesitancy
  • Dengue
  • HIV
  • Ebola, other pathogens

Report on Magnitude of Substance Use in India

  • The Ministry Social Justice & Empowerment.
  • Based on a survey conducted by the National Drug Dependence Treatment Centre (NDDTC) .
  • Under the AIIMS, Delhi.
  • Covered general population (10 - 75 years) in all the 36 states and union territories.


  • India is home to 16 crore people who consume alcohol.

States with high prevalence (among men) :

  • Chhattisgarh (35.6 %)
  • Tripura (34.7 %)
  • Punjab (28.5 %)
  • Arunachal Pradesh (28 %)
  • Goa (28 %)

States with largest prevalence (among women) :

  • Arunachal Pradesh (15.6 %)
  • Chhattisgarh (13.7 %)

States with high prevalence (among children) :

  • Maharashtra (3.8 %)
  • Punjab (6 %)
  • As per the reports More than 3.1 crore Indians (2.8 %) have reported using cannabis products (Bhang, Ganja, Charas, Heroin and Opium) .
  • Higher Cannabis consumption as compared to the national average in Uttar Pradesh, Punjab, Sikkim, Chhattisgarh and Delhi.
  • The prevalence of cannabis use disorders is considerably higher in Punjab and Sikkim than the national average.
  • Sedatives and inhalants are being used by nearly 1.18 crore people.
  • Nearly 8.5 lakh people in the country have been reported with injection of drugs.

Injection of Drugs is more prevalent in

  • U. P.
  • Punjab
  • Delhi
  • Andhra Pradesh
  • Telangana
  • Haryana
  • Karnataka
  • Maharashtra
  • Manipur
  • Nagaland

RTS, S or Mosquirix-World՚s First Malaria Vaccine

  • A pilot program related to a new malaria vaccine, RTS, S, or Mosquirix.
  • Began in the African country of Malawi.


  • A potentially life-threatening parasitic disease.

Caused by the parasites:

  • Plasmodium viviax (P. vivax)
  • Plasmodium falciparum (P. falciparum)
  • Plasmodium malariae (P. malariae)
  • Plasmodium ovale (P. ovale)
  • Parasite transmission occurs by the female Anopheles mosquito.

RTS, S Vaccine

  • The only vaccine that could significantly reduce malaria in children.
  • A scientific name given to this malaria vaccine candidate representing its composition.
  • Triggers the immune system to defend against the first stages of malaria.
  • Vaccine is designed to prevent the parasite from infecting the liver.
  • The vaccine has been developed by GSK (former GlaxoSmithKline) in 1987.

Case with India

  • Ranks very high in the list of countries with a serious malaria burden.
  • Statewise brunt of malaria:
  • Odisha (40 %)
  • Chhattisgarh (20 %)
  • Jharkhand (20 %)
  • Meghalaya, Arunachal Pradesh, and Mizoram (5 - 7 %)
  • Tribal areas of Maharashtra and Madhya Pradesh (90 %)
  • In 2018 3,99, 000 cases of malaria were reported along with 35 deaths.
  • Also it has been observed that 60 % to 80 % of patients in the urban areas are treated by private doctors or health establishments, most of whom do not notify cases.


  • An international non-profit team of innovators.
  • Works with various stakeholders towards the development of a malaria vaccine.

Advises and partners with:

  • Public institutions
  • Businesses,
  • Grassroots groups
  • Investors to tackle serious global health problems

Global Stats on Measles Elimination

  • World Health Organisation.
  • Elimination of measles by Srilanka.


  • A serious and highly contagious disease.
  • Cause debilitating or fatal complications, including encephalitis, severe diarrhoea and dehydration, pneumonia etc.
  • Preventable through two doses of a safe and effective vaccine.
  • Rubella commonly known as German measles can have severe consequences during pregnancy.

Global Measles Vaccination

  • As per WHO since 2000, over 21 million lives have been saved through measles immunization.
  • Global coverage with the first dose of measles vaccine-85 % .
  • Second dose coverage stands at 67 % .

Performance of India

  • To tackle both measles and rubella India has currently given a miracles rubella vaccine in its universal immunization programme.
  • Targeted elimination of measles and control of rubella by 2020.
  • Th number of rubella cases need to be reduced by 95 % as compared to the number of cases in 2008 to achieve Rubella control.

The latest Global Measles and Rubella Update:

  • India reported 47,056 measles cases.
  • 1,263 rubella cases during April 2018- April 2019.
  • Under the MR campaign in February 2017 and as of Nov 2018 nearly 135 million children have been vaccinated in 28 states/UTs.
  • Under the programme, two doses of measles and rubella vaccines are to be given at ages 9 - 12 months and 16 - 24 months.

Health Index 2019-NITI Aayog

  • Release of the second edition of NITI Aayog՚s Health Index was recently.
  • Report titled ‘Healthy States, Progressive India: Report on Rank of States and UTs’ .

Index Ranking of the States and Union Territories Based on 23 health-related indicators:

  • Neonatal mortality rate
  • Under-five mortality rate
  • Proportion of low birth weight among new-borns
  • Progress in treating tuberculosis and HIV
  • Full immunization coverage
  • Improvements to administrative capability and public health infrastructure
  • Proportion of districts with functional Cardiac Care Units
  • Proportion of specialist positions vacant at district hospitals

Report Highlights

  • Among the 21 large states, Kerala continued to top the list for the best performing State in the health sector.
  • Kerala was followed by Andhra Pradesh, Maharashtra, Gujarat and Punjab, Himachal Pradesh, Jammu and Kashmir, Karnataka and Tamil Nadu.
  • Kerala got a score of 74.01.
  • Uttar Pradesh was the worst performer at the bottom of the list with its score falling to 28.61.

Additional distinction of making incremental progress:

  • Andhra Pradesh
  • Other states at the bottom of the list are Bihar (32.11) , Odisha (35.97) and Madhya Pradesh (38.39) .
  • Chandigrah with a score of (63.62) among the UTs followed by Dadra and Nagar Haveli, Lakshadweep, Puducherry, Delhi, Andaman and Nicobar and Daman and Diu (41.66) .
  • Only 3 states Rajasthan, Jharkhand and Chhattisgarh showed improvement in the overall performance among the 8 Empowered Action Group States.

Promoting E-Pharmacies

  • Will bring down the price of medicine for Indian patients.
  • Operate through websites or smartphone apps on the Internet.
  • Medicines for sale at a discount of at least 20 % when compared to traditional pharmacists.
  • Patients can submit photographs of prescriptions while placing orders for scheduled drugs.

Barriers for the Entry of E-Pharmacies

  • Promote competition.
  • Effect on lowering the price of medicine for Indian patients.
  • Patients have to pay higher prices as the Pharmacists (artificial inflation of medicine prices) prefer to enter into agreements with each other so as to fix the price.
  • Creation of huge distortions in the Indian market.

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