STIs and HIV in India

STIs and HIV in India

 

Part 1: Outline what is known of the current situation in relation to the epidemiology of STIs
and HIV and who carries the burden of STI and HIV disease in the country of choice.
? Introduction to identify the epidemic.
? Current situation in relation to epidemiology of STIs and HIV.
Who carry the burden of the disease? Concentrate on the following main at risk groups (Then you brooked down to the at risk population):
? Sex workers.
? Man who have sex with man (MSM).
? Drug user altitudes.

? Stigma and discrimination.

Part 2: You have a generous budget for use in a non-government organisation in this country.
On the basis of your knowledge of the epidemiology of STIs and HIV, the relevant biomedical
features of infections and who carries the burden of disease, decide on priorities and
programmes for expenditure in the prevention of STIs and HIV in this country.
Note:
? The first Learning Activity in Module Two may be of some assistance in developing
this essay (page 2.10) (note: I will send them in separate file).
? Reading through modules 7 and 8 at this stage will give you an overview of many of
the current approaches to HIV/STI prevention and issues to be aware of in devising
interventions (note: I will send them in separate file).
Further tips for the assignment:
? What STI and HIV priorities would you target and why?
? Remember to outline programmes you would implement.
? What population groups would you target and why?
? Bear in mind cultural contexts in the country you have chosen.
Please use the following general comments that provide an overview of the assignment (they were given by the supervisor to one of the students last semester) so if you can follow these comments, it will be very helpful for you to give good essay), please use them:
Part 1
Epidemiology of STI/HIV
? It is important to identify the type of epidemic at the beginning so that the reader can then identify if the interventions are appropriate
? Is quantitative and qualitative data collected in the country?
? In addition to prevalence and incidence, are behavioural changes are underlying determinants monitored? How accurate is current reporting thought to be in the country under study?
? Risk behaviours amongst different sections of the population need to be discussed and underlying reasons for these behaviours ? which are often related to the broader socio-economic and political environment where people live.
? In considering the epidemiology of STI and HIV disease a brief discussion of routes and modes of transmission is needed ? how STI/HIV disease is being spread for example through CSWs? MSM? IDUs? Contaminated blood products? And then passed to women through normal heterosexual routes

Globally women bear the burden
? Globally the great majority of the disease burden from STIs is carried by women. This is not only due to the prevalence of STI/HIV infection in women but also partly due to the nature of STI infection.
? Women are often asymptomatic and when untreated, infection results in long-term reproductive health problems like infertility and still births.
? Women also often carry the burden of care of infected individuals and female children are more likely than male children to have to drop out of school as a result of family member having HIV.
? The presence of STIs can also have a socio-economic impact. Women particularly may be stigmatised, lose self-esteem, suffer financially and have difficulty accessing adequate care.

Stigma
? Is there any stigma attached to being HIV positive or having STIs?
? Are HIV positive men and women treated equally?
? Is there any stigma attached to being a widow/widower of a HIV patient? Do men and women have equal chances of remarrying?

Part 2
General strategies
A useful framework for considering strategies once disease priorities and target groups have been identified and these generic strategies can be tailored to specific groups identified as priority:
? promoting safe sex behaviour;
? advocating of condom use;
? promoting health care seeking behaviour;
? integrating STD control into primary health care and other health care services;
? providing specific services for populations at increased risk;
? comprehensive case management; and early detection of infections

Testing
? Testing is a key strategy.
? Not only does it help get people into treatment centres to reduce the burden of disease, it also allows access to infected persons for education. And it also allows for surveillance.
? If a country doesn?t have a strong established surveillance system, the testingcentres that you put up can work as surveillance sites.

Effective HIV prevention
? An effective HIV prevention campaign includes health education, and empowerment.
? By stigmatising IDUs and CSWs, they are isolated further, forced underground and less accessible for possible preventative interventions and educational campaigns.
? It may also be hard for health workers to provide appropriate health care and support for safer behaviours to high-risk sub-groups.
? With no political commitment to marginalized groups the government may find it unacceptable for NGOs to set up health services in areas where CSWs work or to provide subsidized condoms and needle exchange services.
? Foreffective screening and behavioural surveillance, marginalised groups need to access facilities so that they can be used as sentinel sites for STI/HIV surveillance.
? Migrant populations, young mobile men and CSWs have multiple sexual partners ? these populations should also be key target groups for STI/HIV prevention activities.

Peer education programmes
? It is good to use people who have similar characteristics with those you are trying to reach. Eg: using peers i.e. training sex workers to teach each other about condom use, strategies on negotiation of condom use with clients etc.
? Once again with no political commitment, it also makes other interventions, such as peer education programmes which aim to empower participants and provide life skills, difficult for health workers to organise effectively.
? Individuals may be too afraid to participate in such programmes even if they are available and there is a desire to attend, because of a fear that their participation will mark them as a ?criminal? and that they will be reported to the authorities and possibly arrested.

Treatment of STIs may be easier than HIV which needs a large and long time commitment. It is also easier to provide testing services with STI treatment. HIV treatment should be left to hospitals and governments so that it can be monitored and evaluated.

An excellent assignment sir Sunil Kumar
Please see my comments in text and the marking rubric/criteria on the next page

 

STI AND HIV IN INDIA

Introduction
Sexually transmitted infections (STIs) is the term that has replaced the term Sexually transmitted diseases (STDs). Sexual transmission needs the infective agent to be present in one partner and transferred to the other susceptible partner. It includes many diseases like gonorrhea, syphilis, nongonococcal urethritis, donovanosis, genital warts, chancroids, herpes genitalis which cause infections in genital area and human immunodeficiency virus (HIV), HTLV-1, hepatitis B that do not cause clinical disease in genital area (1). Sexually transmitted infections (STIs) are very dynamic from any other disease prevailing in the community and vary between different countries and between different regions in a country depending upon the demography, ethnicity, health and socioeconomic factors (2). AIDS and HIV-1 infections are public health concerns globally. The first case of AIDS was reported from USA in early 1980s. And by January 1988, atleast one case from each of 129 countries was reported to the World Health Organisation (WHO) (3). In India, the first cases of HIV were detected in late 1986 among sex workers in Chennai, Tamilnadu and till the year 2005 there were more than five million people infected with HIV out of a total population of 1.02 billion (4). Since India has a large population, even low prevalence converts itself into large number of HIV infected patients. Because of poor socioeconomic status of majority and poor health services, the spread of STI/HIV needs to be controlled early and effectively. National AIDS Control Organisation (NACO) was established in 1992 under the Ministry of Health and Family Welfare to take the initiative of establishing HIV testing centres, improving blood safety and controlling hospital infection (5). Still large number of areas remain underserved.

Part 1 – Current situation in relation to epidemiology of STIs and HIV
Sexually transmitted infections are a major public health problem in both developed and developing countries. India is big country and the pattern of STIs prevalence in different geographic areas are different (1). In India, HIV epidemic is of heterogenous in spread and concentrated in nature.
Epidemiology of STIs and HIV:
Heterogenous Spread:
A study conducted in Pondicherry, south India revealed HIV prevalence of 15.14%. The annual trend was of increase from 8.6% in 1993 to 23.52% in 1997. Genital herpes was most common STI, which was followed by syphilis, condyloma acuminata and others (6). In a study conducted in Chandigarh, a city in north India, the commonest disease was condyloma acuminata (21.4%), which was followed by gonorrhoea (7). While in Udaipur, a city in western India, the highest incidence was of chancroid (37.7%) (8). In a data analysis in North-Eastern States of India, in Guwahati, 9.62% had

 

Fig 1: Map of India showing high HIV prevalence regions
(Source – http://www.avert.org/aidsindia.htm)

HIV infection. 25.77% were had chancroid (9). In a study conducted in Cuttack in the state of odisha, the highest incidence was of herpes progenitalis (21.89%) . HIV infection was found in only 3 cases, which came out to 0.56%. (10). A cross sectional study carried out in 17 tribal villages in a block of Jabalpur district in Madhya Pradesh revealed gonorrhea as most common in males while trichominiasis in females (11). This study does not mention of any positive cases of HIV.
Concentrated Distribution:
HIV prevalence is concentrated in nature. Its prevalence is 20 times higher in female sex workers, injecting drug users, truckers, transgenders and men having sex with men as compared to general population. According to report of National AIDS Control Organisation (NACO) for the year 2009-2010, updated on 17 Aug 2011, India had adult prevalence of 0.31 percent which converts to number of 2.39 million people infected with HIV. Of these numbers, 39 percent are females and 3.5 percent are children (12). It also showed decline in new infections by 50 percent in the previous decade. The number of new HIV infections in the year 2000 was 2.7 lacs which came down to 1.2 lac in the year 2009. Adult prevalence of HIV among adult men was 0.38% and among women it was 0.26% in the year 2008 and in the year 2009 it was 0.36% for men and 0.25% for women. The state of Manipur had highest prevalence of 1.40%, which was followed by Andhra Pradesh with 0.90% (12).
Current Prevalence:

Fig. 2 : HIV Prevalence: India, 2008-09(12) (Source: HIV Sentinel Surveillance, 2008-09)
The figure 2 shows the prevalence of HIV among the different groups of people. Injecting drug users have got the highest prevalence among that group, followed by men having sex with men. The lowest prevalence was found among the women attending antenatal clinics.
Declining Trend:
Adult prevalence had been steadily decreasing over the years at national level. In the year 2000, the prevalence was 0.41 percent, which in the year 2006 came down to 0.36 percent and further down to 0.31 percent in the year 2009. All the high prevalence states showed decline in the HIV prevalence. But contrary to that, the low prevalence states showed rising trend in adult HIV prevalence in the previous four years. Among the young population (15-24 yrs) there is a clear declining trend in HIV prevalence in both men and women (13), (12). In a study conducted in an antenatal clinic of a hospital in Pune in Maharashtra, the overall prevalence was 0.6% and among antenatal women it was 1.1% in year 2003, which came down to 0.2% in the year 2008, a reduction of 82% over this period. There was a significant decline in infections in young women below 24 years of age, indicating thereby a decrease in number of new infections among young women below 24 years of age (14).
Routes of Transmission:
The major route of transmission of HIV is unprotected sex, which is 87.4% with heterosexuals and 1.3% with homosexuals. This is followed by parent to child transmission of 5.4%, injecting drug use accounts for transmission in 1.6% and injection of infected blood and blood products 1.0% (12). Among the unprotected sex, unprotected anal sex has more risk than unprotected vaginal sex and among men having sex with other men, unprotected receptive anal sex is riskier than unprotected insertive anal sex. Sharing needles, syringes, rinse water used in preparation of illicit drugs for infection also has risk for HIV infection. HIV can also be transmitted from mother to child during pregnancy, chilbirth or by breast feeding. Unsafe or unsanitary injections or other dental practices and the less common modes are being stuck by HIV-contaminated needle or other sharp object, this is for healthcare workers (15).
Who carries the burden of STIs and HIV – Main Drivers:
The main drivers for STI and HIV in India are the high risk group of female sex workers, men having unprotected sex with men, injecting drug users, transgenders and the bridging population is of truckers and migrants. HIV is transmitted from high risk group to the general population through the bridging population who are the clients of sex workers like the truck drivers and the single male migrants (12).
Female Sex Workers:
Female sex work or prostitution has a long history in India and the male clients of sex workers have a heterogenous mixture of socioeconomic strata of society. The females sex workers can be divided in four groups on the place of their work. These are brothel based, street based, home based part time and call girls (16). The epidemic of HIV started with the female sex workers at the beginning but it has relatively been stable for a while because of the targetted interventions in this group (17).
Non Commercial, Non marital Sex:
The other group is non-commercial, non-marital sex which is reported to be about 7-48% in males and 3-10% in females. Though premarital sex is not the norm, men have different premarital sex partners like sex workers, friends, relative and future spouses. Whereas, females had sex with mainly future spouses, friends and relatives (18).
Mobile Population:
While some studies in STI clinics and truck drivers have reported 81-98% premarital and extramarital sexual encounters. A study in 2008 showed that about one third of the truck drivers had paid sex within the previous twelve months (19). The other important group is the single male migrant labour. There is migration of large number of male labour from the states of Bihar and eastern U.P. and the destinations are high prevalence states of Maharashtra, Andhra Pradesh and Karnataka (20). They indulge in sexual activities with female sex workers where they work and they transmit the infection to others enroute and to their wives when they go home after long periods.
Men having sex with men and transgenders:
The other group is of men having sex with men which has a high prevalence of HIV infection. MSM in India do not categorise themselves as homosexual and usually they have regular sex with their female partners. In a study conducted in Andhra Pradesh, 51% of these men reported having sex with a woman in the previous three months with reported condom use of 44% for male partner and 16% for female partner (21). This group works as bridging population. As per the NACO report of 2010, the HIV prevalence among MSM is 7.3% (12).
Mother to Child transmission of HIV:
There are about 27 million live births per year in India and the prevalence of HIV among antenatal women is 0.1 to 2.25% in the country. At present the HIV positive mothers are given single dose of Nevirapine at the time of labour and another dose 72 hours after childbirth. Mothers are told about the risk of transmission of HIV by breat milk (22). Studies have shown mother-to-infant transmission of HIV from 36 to 48% (5).
Injecting Drug Users:
In Manipur, the seropositivity for HIV increased from 0 to 50% within six months from 1989 and is reported to be above 75% at present. Spouses of HIV-positive injecting drug users had a prevalence of 5.9% and antenatal mothers had a prevalence of 2%. This group of IDUs mainly consists of mostly males aged 15 to 30 years and the female sex workers. In another study 75% were HIV positive, most were about 19 years of age, two thirds were sexually active and only 3% used condoms regularly. They transmit infection to their partners and wives (23, 24). Nationally the prevalence in Injecting drug users declined to 7% in 2006 but then it rose up to 9.2% in 2009.
Part 2: – Prevention of STIs and HIV in India
For Female Sex Workers:
As this is the biggest group which may make an impact in the HIV infectivity, it needs multipronged approach to contain the infection. Sonagachi project had impressive results in Kolkata. Condom use increased from 27% in 1992 to 82% in 1995 and HIV prevalence came down from 11% in 2001 to 4% in 2004 (25). This project type was taken as model HIV/AIDS intervention by W.H.O. (26). The same model would be adapted. Health promotion projects will be launched in every redlight area of every city by setting up a health centre to look after the health of the sex workers as also of their families, especially their children.
Firstly, brothel owners will be motivated and taken into confidence regarding the wellbeing of FSWs and HIV risk. Peer outreach workers shall be recruited from amongst these sex workers who are a little literate. These peer educators will in turn provide safe sex education and awareness of risks of HIV/STI infections by going from home to home of the FSWs. They will also be providing condoms to the sex workers. The FSWs shall be educated about their rights to have safe sex and to insist on use of condoms by their clients (27). They will take them to the health centre for diagnosis of HIV and other STIs and further treatment. This shall be free of cost to the FSWs. Condom wending machines shall also be installed in every redlight area.
For Non Commercial, Non marital Sex:
To prevent STI/HIV in this group which is very large in some studies and is difficult to find out. Moreover, they do not accept that they indulge in casual sex, as this is not the norm. They shall be educated about safe sex and risks of STI/HIV by mass campaigns through the media. Campaigns shall be launched in print, posters, banners, audio visual media and through the health workers. The campaigns shall be without censors, looking into the local cultural values, and shall be promoted in the local language in each area. Free condom vending machines shall be put up in all the localities.
For Mobile Population:
Migrant labour and truck drivers which constitute the major chunk of mobile population are mainly young between 18 and 29 years of age (20). The labour work force is mainly operating through labour contractors and the truckers operate through the transport agencies. So, for the migrant labour the labour contractor and for truckers, transporters shall be motivated to bring them into the education network for safe sex education and STI/HIV prevention methods. Labour contractors and transporters shall be asked to get the HIV status tested for their workforce and new recruits before their induction. This shall be done free of cost to the labour as also to the employers. They they shall be provided free condoms and investigated for HIV status periodically. Those found positive for STI/HIV shall be provided treatment and monitored thereafter.

For Men having sex with men and Transgenders:
Gay community and transgenders shall be reached by outreach pragrams and peer education shall be started by passing messages which are culturally appropriate and are in their own language about the risks of unprotected sex among their partners. Accurate and uncensored information about the risks involved in any type of sexual activity which may be hetero, homo, bisexual or of any kind like vaginal, oral and ano-rectal shall be included in all the educational material for HIV prevention. This shall be done so that it is not seen as taboo. High quality condoms with lubricants which are suitable for anal intercourse shall be made available to them. These are at present inaccessible and unaffordable (28).
For Mother to Child transmission of HIV:
Test for HIV status in pregnant women is being done in all the hospitals in India. Still, 50-75 percent of women do not get medical attendance for the child birth and deliver at home (29). Health counselling shall be done in rural areas by the health workers of the NGO. The pregnant women would be counselled to avail medical facility and shall be screened for HIV. Positives would be provided the AZT therapy and would be counselled by the workers about the risk of transmitting HIV to the child by breast milk and advised to give milk powder, which shall be provided to them free of cost, so that they are motivated to use that.
For Injecting Drug Users:
A peer outreach programme with emphasis on experience sharing shall be done by using a cadre of peer educators. Those who have left injecting drugs shall be enrolled as Peer Educators and shall be provided training in communication methods. They will counsel the injecting drug users about risky behaviour of unsafe sex. The IDUs and their partners will be provided free supply of condoms and emphasised to use it regularly. They shall be taught about safe drug injecting practices and supplied disposable syringes and needles free of cost so that they do not reuse the same (30). A systematic enrolment of all the IDUs will be done and their HIV status monitored every six months by testing seropositiveness. Those found positive shall be provided counselled to continue the treatment of HIV and made sure that they do not leave the treatment in between.
Conclusion:

The main impediment to effective control of AIDS/STI in India is insufficient resources, social stigma, illiteracy. But all the prevention and control programs need to be directed towards target groups of population. It is difficult to control AIDS as it is less of a medical problem and more of cultural, social and developmental problem. Approaches like condom promotion, case detection and management of STIs, safe blood transfusion and drug de-addiction will give quick results but for long term prevention and control multidisciplinary approaches like removing social injustice and inequality, improving economy, increasing the status of women in society, development of safe and effective vaccines for primary prevention and overall development are needed.
References:

1. Thappa D.M. KS. Sexually transmitted infections in India: Current status (except human immunodeficiency virus/acquired immunodeficiency syndrome). Indian Journal of Dermatology. 2007;52(2).
2. Sharma V.K. KS. Changing patterns of sexually transmitted infections in India. National Medical Journal of India. 2004;17(6).
3. Piot P, Plummer F, Mhalu F, Lamboray J, Chin J, Mann J. AIDS: an international perspective. Science. 1988 February 5, 1988;239(4840):573-9.
4. Sivaram S. LCA, Solomon S., Celentano D.D. HIV Prevention in India: Focus on Men, Alcohol Use and Social Networks. Harvard Health Policy Review. [Review]. 2006;7(2).
5. Godbole S. MS. HIV/AIDS epidemic in India: risk factors, risk behaviour & strategies for prevention & control. Indian J Med Res. 2005;121.
6. Thappa D.M. SS, Singh. A. HIV infection and sexually transmitted diseases in a referral STD centre in south India. Sexually Transmitted Infections 1999;75.
7. Kumar B. BV. Pattern of sexually transmitted diseases in Chandigarh. Indian Journal of Dermatol Venereol Leprology. 1987;53.
8. Bansal K.N. KKA, Upadhyay P.O. Pattern of sexually transmitted diseases in and Around Udaipur. Indian Journal of Dermatol Venereol Leprology. 1988;54.
9. Jaiswal A.K. BS, Matety A.R., Grover S. Changing trends in sexually transmitted diseases in North Eastern India. Indian Journal of Dermatol Venereol Leprology. 2002;68(2).
10. Mohanty J. DKB, Mishra C. Clinical profile of sexual transmitted diseases in cuttack. Indian Journal of Dermatol Venereol Leprology. 1995;61(3).
11. Rao VG, Anvikar, A., Savargaonkar, D., Bhat, J. Sexually transmitted infections in tribal populations of central India European Journal of Clinical Microbiology and Infectious Diseases. 2009;28(11).
12. NACO. Annual Report 2009-2010. 2011 [cited 2011 18 Aug 2011]; Available from: http://nacoonline.org/upload/REPORTS/NACO%20Annual%20Report%202010-11.pdf.
13. Gupta S, Gupta R, Singh S. Seroprevalence of HIV in pregnant women in North India: a tertiary care hospital based study. BMC Infectious Diseases. 2007;7(1):133.
14. Kulkarni V, Joshi S, Gupte N, Parchure R, Darak S, Kulkarni S. Declining HIV prevalence among women attending antenatal care in Pune, India. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2011;105(6):315-9.
15. CDC. Basic Information about HIV and AIDS – HIV Transmission 2011 [updated August 3, 2011]; Available from: http://www.cdc.gov/hiv/topics/basic/index.htm#spread.
16. National AIDS Control Organization GoI. A summary of the findings of the high risk behaviour study from 18 cities. New Delhi1997.
17. Brahme R MS, Sahay S, et al. Correlates and trend of HIV prevalence among female sex workers attending sexually transmitted disease clinics in Pune, India (1993?2002). . Journal of Aquired Immune Deficiency Syndrome. 2006;41.
18. Savara M SC. Sexual behaviour of urban, educated Indian men: results of a survey. Journal of Family Welfare. 1992;38.
19. Pandey A. BSKea. Risk behaviour, sexually transmitted infections and HIV among long-distance truck drivers: a cross-sectional survey along national highways in India. AIDS. 2008;22(Suppl5).
20. Saggurti VNea. HIV risk behaviours among contracted and non-contracted male migrant workers in India: potential role of labour contractors and contractual systems in HIV prevention. AIDS. 2008;22(Suppl5).
21. Dandona L. DR, Gutierrez J.P. et al. Sex behaviour of men who have sex with men and risk of HIV in Andhra Pradesh, India. AIDS. 2005;19.
22. Solomon S, Solomon SS, Ganesh AK. AIDS in India. Postgraduate Medical Journal. 2006 September 1, 2006; 82(971):545-7.
23. Sarkar S. DNea. Rapid spread of HIV among injecting drug users in north-eastern states of India. In: Crime UNOoDa, editor.: Bulletin on Narcotics; 1993. p. 91 to 105.
24. Eicher A.D. CN, Benjamin S. et al. A certain fate: spread of HIV among young injecting drug users in Manipur, north-east India. AIDS Care. 2000;12.
25. Dutta M.K. MD, Jana S., Singh P. Strategizing peer pressure in enhancing safer sex practices in brothel setting. International Conference on AIDS; India: National Library of Medicine; 2002.
26. Nagelkerke N.J. JP, de Vlas S.J., Korenromp E.L., Moses S., Blanchard J.F., Plummer F.A. Modelling HIV/AIDS epidemics in Botswana and India: impact of interventions to prevent transmission. Bulletin World Health Organisation. 2002;80(2).
27. Jana S, Basu I, Rotheram-Borus MJ, Newman PA. The Sonagachi Project: a sustainable community intervention program. AIDS Education & Prevention. 2004;16(5):405-14.
28. Chakrapani V. KARea. HIV Prevention among men who have sex with men (MSM) in India: Review of current scenario and recommendations2002.
29. Singh S. RLea. Barriers to Safe Motherhood in India. Guttmacher Institute; 2009.
30. Council P. Injecting Drug Users In India. 2007; Available from: http://www.popcouncil.org/pdfs/IndiaUpdate/IndiaUpdate_DrugUsers.pdf.
A couple of other points with regards to the assignment:

1. Make sure you read the assignment question thoroughly and that your research and subsequent assignment address both all aspects of the assignment brief and the marking criteria. I understand that you have issues that you have come across in your work, life or study that fire your imagination or passion, but do not allow yourself to either drift off topic or concentrate too much on this one issue at the expense of other factors that also require discussion.
2. Be sure to try and access the latest data available for such rapidly evolving situations as HIV and STI in your chosen country. For HIV, most countries affected by HIV have national AIDS bodies, and the UNAIDS country specific page usually has an epidemiological fact sheet and links to the latest available UNGASS report; however some countries are better than others at meeting their obligations in that regard, and your tutors are aware that it is not always possible to get data for the last couple of years. For STI data again look at government web sites and national health surveys and country specific pages in such entities as WHO, CDC, etc. Be sure also to give the year that any data that you present refers to.
3. A brief explanation for any of you who may be looking at the Indian government?s National Aids Control Organisation (NACO) report that I alerted you to earlier. When reading this report the labels lakh and crore referred to in the document are units used in South Asian numbering systems and represent 100,000 and 10,000,000 respectively; e.g. 1.5 crore would equate to 15 million.( I will attach this report about India in separate file so please have a look to it!!!!!)

Assignment presentation and submission

These notes reiterate, particularly to those of you new to writing within the health sciences field, the requirements of Assignment presentation and submission within Health Sciences at uni; these?points are also summarised in your unit outline and the marking criteria.

Your assignment should be in either Times New Roman font size 12 or Arial size 11, 1.5 spaced and must include:

? Cover page with your name, student number, email address, University Faculty/School, unit, tutor, due date and disclaimer affirming that this is your own work;
? The content should be presented under appropriate headings (and subheadings if needed);
? Page numbers and Contents table;
? A labelled introduction and conclusion as described in the marking criteria.
Your assignment should be submitted as a Word document through Blackboard and labelled:
. Note that this style of writing is more that of a report than essay and you are expected to use headings. This guide also contains useful illustrated examples of the conventions of five most commonly used referencing styles. You will also find other resources to assist in assignment writing in this section of Blackboard, including the ?illustrative assignment?.

I hope this is of some assistance and please don?t hesitate to contact if you have any queries.

Sourcing Information
In response to a couple of queries about sourcing material for the assignments, and especially those of you who are new to study at Curtin, here are some notes and tips on accessing reliable and reputable data for topics you may be interested in investigating either for assignments or your own interest.
? In many cases the first place to start would be to look at the reference list of the readings in your modules and to access any of interest through the Curtin library catalogue, databases or the Find it resource. You can then snowball on further.
? You can search for journal articles directly using keywords related to your topic in the Curtin library extensive list of databases. Useful databases to consider for health topics include: Medline; PubMed; ProQuest; PsycInfo; ScienceDirect; Web of Knowledge.
? N.B. For those of you who are unsure of how to search a database, the library has some useful tutorials on assignment writing and sourcing material in either video or print form; go to ?library?>>?LibGuides? (top item in box on right hand side) >> ?Study skills? >> and then choose from the various topics offered.
? Search through reputable web resources including:
? Any of the relevant United Nations (UN) websites such as UNAIDS, UNICEF, UNDP, UN Women, UNHCR etc.;
? World Health Organisation (WHO);
? International organisations such as World Bank, Asian Development Bank (ADB), Medecins sans Frontieres (MSF), Human Rights Watch (HRW), International Federation of the Red Cross and Red Crescent Societies (IFRC), European Union (EU), CDC.
Many of these organisations release annual reports giving the global and individual regional and/or country overview of HIV and STI and factors that affect transmission such as gender issues, IDU etc. and their web sites may also be good sources of country specific data and statistics; e.g. if choosing to look at STI and HIV in Russia, the EU, which you may not think of in this context, collates surveillance data on STI and HIV in continental Europe and is a good source of comparative data. As mentioned in the modules the UNGASS country reports (available through UNAIDS either in the dedicated page: [http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/] or the country specific sites) are also a good source of country specific HIV and AIDS data and give a good overview of the state of the epidemic and government response. National governments also often release the annual reports of their variously named national AIDS organisations and STI data may also be available through national health and behavioural surveys.
? If researching Australian populations such as indigenous health issues, the Australian Institute of Health and Welfare (AIHW), Australian Bureau of Statistics (ABS), Australian Indigenous Health Infonet are good sources of current Australian data.
? Google Scholar is also a reputable avenue through which to source academic journals and many are free to download; if you can only download the abstract, the full article can be accessed through the Curtin library catalogue via ?Find books and resources? >> ?Journals?. NB If the journal doesn?t first come up try altering the ?starts with? button to the ?contains? or vice versa.

Note you must be selective in your use of web based resources. Sites such as Wikipedia, www.answers.com and Google books ARE NOT acceptable academic sources.

Further tips
? Unless you are interested in or citing a seminal work or classic study or presenting historical and cultural material, or comparison data, use up to date sources no more than 10 years old, particularly when discussing health issues or rapidly evolving situations such as STI/HIV;
? Remember to tick the peer reviewed journals only option when searching for journal articles;
? If using newspaper articles ? remember to record the date in full, the newspaper and URL of the web link.
? When using web based sources, remember to include the URL of the page from which you accessed the material, not the generic URL of the organisation and to follow the protocols of your chosen referencing style for in-text and referencing list entries; do not use URLs in-text.

As a general comment be sure that you address STI as well as HIV in your country case study sand be sure to give the year that data you present refers to.
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