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.