Ralph R. Frerichs

Satellite Session. Fourth International Congress on AIDS in Asia and the Pacific, Manila, Philippines, October 26, 1997

The objective of this evening presentation was to stress the importance of confronting the HIV/AIDS epidemic in India.  Because the disease is highly stigmatized, there is a tendency in most countries to ignore the problem, waiting until silent HIV infection appears as overt AIDS symptoms.  Since this takes about 9-10 years, the epidemic is typically well underway before its presence is recognized by the general public.  Epidemiologists in Thailand have established a model sentinel surveillance system that detects HIV infection (rather than AIDS) among high and low risk groups, letting people know that the infection is present and becoming more common.  The intention of this presentation was to share insights from Thailand with health professionals in India, and discuss the use of surveillance data for setting public policy. 

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Suggested Readings

  • Frerichs, R.R., Ungchusak, K., Htoon, M.T., and Detels, R. HIV sentinel surveillance in Thailand - An example for developing countries. Asia-Pacific Journal of Public Health 8(1):20-26, 1995.

  • Frerichs, R.R. and Seymour, E. HIV testing and blood recipients. Lancet 342:1549, 1993.

  • Frerichs, R.R. Personal screening for HIV in developing countries. Lancet 343:960-962, 1994.

  • Frerichs, R.R., Silarug, N., Eskes, N., Pagcharoenpol, P., Rodklai, A., Thangsupachai, S., and Wongba, C. Saliva-based HIV antibody testing in Thailand. Aids 8:885-894, 1994.

  • Wongba, C., Pagcharoenpol, P., Eskes, N., Frerichs, R.R., and Silarug, N. HIV saliva test for surveillance and surveys. Aids 9(9):1104-1105, 1995.

  • Schopper, D. and Vercauteren, G. Testing for HIV at home: what are the issues? Aids 10(13):1455-1465, 1996.

  • Frerichs, R.R. Harm of not permitting personal HIV screening in developing countries. Aids 11(7):936-937, 1997.

  • Frerichs, R.R. HIV winners and losers. Epidemiology 6(3):329-331, 1995.


Angry Participants

The presentation was not well-received, with many participants from India and some from UNAIDS displaying anger and concern.  An anonymous reporter for the Conference proceedings described what occurred:

There was one satellite symposium, on HIV/AIDS and India, which was quite heated, with Dr Ralph Frerichs drawing the ire of Indian delegates for his push of mandatory testing. The Indians' reactions were not so much on the unscientific nature of mandatory testing than their perception of "colonialism," of a westerner again trying to impose "solutions," in this case one that has been completely discredited. The satellite symposium did, however, show how old issues do not necessarily die out. While everyone seems to agree that mandatory testing is bad policy, the fact remains that many countries in the region do in fact require such testing especially for foreign workers, often with little or no pre- and post-test counseling.

In the years following the 1997 presentation, the HIV epidemic in India has continued to increase.  While sentinel surveillance programs have been established, the use of surveillance findings to guide HIV control strategies such as widespread testing, case-education and management, and partner notification remains contentious.