After a prolonged back-and-forth between diverse agencies over actual
HIV/AIDS statistics in India, the figure that India's National AIDS Control
Organization (NACO) has settled on is an estimated 2.5 million people who
are living with the virus in the country, accounting for 13% of global HIV
infections. In India, like in many of the developing nations, these
infections occur primarily during unprotected heterosexual intercourse. As a
result, women are increasingly becoming vulnerable to the disease,
particularly in rural areas. In the face of extreme poverty and illiteracy
coupled with poor health and poorer health care facilities, the task of
tackling the virus is daunting.
And yet it would be naïve to assume that the virus only afflicts certain
groups in certain regions. Despite the fact that HIV came late to India, the
infections have multiplied at such a fast pace that HIV is no longer
restricted to particular communities but cuts across all segments of
society. And while various critical components like sex education, condom
campaigns, contraception and family planning continue to be obstructed by
the fine print of political and social agendas, initiatives within
individuals' and groups' own social milieus raise hopes that we can make
some gains against the virus.
Bringing Prevention Education to Youth, Armed Forces, and Women
Sex education, one of the important tools for dealing with the virus, has
become a political flashpoint between many state governments. So the
country's premier health institution, the All India Institute of Medical
Sciences' (AIIMS) recent initiative could be an important step in the
direction of pre-marital sex education. AIIMS has proposed a 'pre-marriage
course' for individuals who are over 18 years of age and planning to get
married. As a response to the growing incidences of marital discord, sexual
disharmony, and HIV/AIDS and STIs amongst young couples, the initiative aims
at dispelling myths about the human body, sex and contraception while
preparing them physically, socially and emotionally for marriage. A crucial
component of the course is advice on pre-marital screening for specific
genetic and acquired diseases. While currently restrictive by its urban
reach, if successful, it could prove to be an important model for other
government-run health institutions to follow in a manner that they reach the
areas where the information is most crucially required -- particularly where
child marriages continue to dog any real development efforts.
In the battle against HIV another group, who, by the nature of their
engagements and length of deployment, have also been considered high-risk:
the country's security personnel. Yet the exclusionary and closeted nature
of their functioning has made any real statistics on the threat potential
and actual cases difficult to appreciate, putting their spouses back home at
even higher risk of contracting the virus and passing it on further through
pregnancies. However, recent indications point towards a reversal in the
prevalence of HIV/AIDS among the armed forces, with growing awareness about
the virus and preventive measures. According to reports from the Army, in
addition to continuous awareness campaigns there have been concerted efforts
to grant leave to these soldiers, at regular intervals, believed to have
helped in checking newer infections. The forces engaged in
counter-insurgency operations in some of the northeastern states of high HIV
infections were seen as the most vulnerable. Recent figures, albeit
conservative, indicate a drop in new infections among personnel from 144 in
2004 to 35 in 2006.
Basic lack of access to information has seriously hampered prevention
efforts. For years, initiatives hardly took in to account the obstacles of
illiteracy and poverty. Women are not only handicapped by the denial of
education, but also by early marriages and almost immediate pregnancy, often
throwing them into a sexual relationship with a much older man with a
history of risky sexual behavior. In the case of child marriages, the
situation would hardly be any different: the groom is misinformed on the
issues of sex, AIDS/HIV and STIs as is the bride ill-informed, immediately
pushing both into stereotypical societal roles and practices guided by the
pressures of masculinity or/and virility for men and fertility for women.
More recent media messages have clearly targeted the misconception that HIV
afflicts a certain section of the society (like truckers, sex workers or
drug-users) and it is this misreading that over the years had made several
other groups vulnerable to the virus. And even though overall prevalence
remains low, the threat is that even relatively minor increases in HIV
infection rates have the risk of multiplying very fast.
Accessible Testing and Treatment
At a time when accessibility continues to be an obstacle for most affected
or at risk groups, Indian researchers are developing a forty minute,
on-the-spot diagnosis similar to throat swab tests. The kit has already been
used in Wardha, in western India, to test 1003 women, 82% of who were
ignorant about their status. A method quite similar to the pregnancy test,
the feasibility of immunochromatography is in its use even in highly busy,
rural labor rooms in the country. The significance of this method is its
immediate accessibility to rural households, particularly women, who have
suffered high degrees of susceptibility due to lack of access to both
information and laboratories conducting these tests.
The Indian Railways Ministry's fare concessions to positive people
travelling to specific NACO antiretroviral treatment centres (ART) from
April this year, however tokenistic, is still a move in the direction of
accepting AIDS as a ailment like others (railways already offer fare
concessions to people living with various medical conditions like
tuberculosis, leprosy, etc.). While in its current form, the concession
appears to be restrictive in that many of the trains might not even touch
the areas where prevalence is high, the honesty of the effort will be
demonstrated over time if it accommodates to reach as many vulnerable
populations and groups as possible.
Changing Attitudes Towards People Living with HIV
Sensitization towards positive patients still remains a core element of
concern when dealing with the virus. Instances of doctors refusing to treat
AIDS patients, women being thrown out of their marital homes after being
widowed by a positive spouse (despite having been the care-givers), an
adopted child being returned once found to be infected, a dead person denied
a cremation, children of positive parents being denied admission in schools
are just some of the instances of the apathy, stigma and associated
discrimination that positive persons and their families have to continuously
content with. Thus, while containment of new infections is an important
strategy to prevent the spread of HIV both regionally and globally, equally
crucial are human rights concerns guided by empathy for the patient, equal
access to basic facilities and treatment and de-stigmatization.
Though ninety nine percent of the adult Indian population is HIV negative,
any real success in tackling the HIV epidemic lies not in only reversing the
trend in growing infections but in reversing the attitudes towards the virus
and the manner in which positive patients and their families are treated as
well so that they are able to lead healthy lives not just physically but
mentally and socially as well.
