Clinical and Epidemiological Aspects of HIV Infection at a Rural Hospital in Northern India

Village Hospital is a 120-bed rural mission hospital located in the foothills of the Himalayas in northern India. During a two-month senior international health elective, I studied clinical and epidemiological aspects of the human immunodeficiency virus epidemic experienced at Village Hospital. During the first 7.5 months of 2001, there were 73 antibody-based rapid assays conducted at Village Hospital to test for HIV, and 7 of the patients tested HIV-seropositive. No blood donors had positive test results for HIV suggesting relatively low disease prevalence in this area. Eight clinical vignettes are presented which describe the clinical presentation and care of patients with HIV. Indications for testing included extensive tuberculosis, candidiasis, emaciation, chronic fever, and high-risk behavior. Most of the patients who tested seropositive were young men with some form of high-risk behavior. The hospital’s treatment of HIV was entirely palliative. Care was variable reflecting the stigma faced by patients with HIV. However, the community health department’s commitment to educating surrounding villages about HIV was very strong and served as a model of preventive medicine in a developing country.