No Room for Orthodoxy in HIV Prevention

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No Room for Orthodoxy in HIV Prevention

Deepali Gaur Singh

The HIV epidemic in India needs to be fought by accessible testing, lessening stigma, widespread education, and needle exchange programs, but above all, it needs to be fought by a humane and scientific prevention program coming from the government.

Two couples from the district of Guntur in the southern state of Andhra Pradesh, India — despite their limited education and conservative upbringing — managed to send out a powerful message to dispel the myths surrounding HIV by opting for pre-marital HIV testing with the support of their families.

One of the young men getting married is a truck driver — believed to be one of the high risk groups in the country for the virus. With ninety percent of the youth in three districts of the region positively inclined to such tests, the future of controlling the virus looks bright — as long as these young people are not stonewalled by conservative community elders when legislation on the subject comes up or the movement for such testing does gain momentum. The NGO involved in the initiative hopes to make pre-marital HIV testing mandatory.

The subject of sex education in schools already has been stonewalled in many parts of the country. The tussle has been narrowed down to the issue of talking about the act itself with children. The recent incident of early adolescent street children in the eastern Indian city of Kolkata molesting a woman in broad daylight like it was a community game or the burning of a twelve-year-old girl by two fourteen-year-old boys because she resisted there attempts at rape are scary enough for parents (if not other stakeholders) to start taking this issue more seriously. Sex education can arm children, adolescents and young adults with information that prepares them to not just be sexually safer and healthy but also to help them deal with the growing awareness of their own sexuality in a responsible manner — and delay their first sexual encounter to a time when they feel both physically and mentally equipped to deal with the consequences.

Any "unorthodox" attempts at dealing with HIV and other STIs or pregnancy and family planning related issues have over the years met with resistance. For instance, several years ago, a movement to introduce condom vending machines for prison inmates of Tihar (the largest prison complex in South Asia and located in the national capital) was enough to rattle many people.

Sex. Abortion. Parenthood. Power.

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More recently, several agencies have been contemplating making clean syringes available for intravenous drug users (IDUs), considering the risk sharing syringes poses for HIV infection. If the argument here gets reduced to condoning or condemning drug use the price we end up paying will be with more new HIV infections and precious time lost in actually combating the issue.

Changes like these in strategy need to be considered if we don't want to end up taking three steps back for every step forward in dealing with communities on such volatile issues surrounding sexual and reproductive health. The region has already suffered the consequences of sex selection, reflected in the abysmal sex ratio in India, and is a reflection of foot dragging strategies over the past decade and more. And the result? In many districts of the country, there are now fewer than 700 girls for every thousand boys, with a situation not that different to the one in China.

Even tough India found cheer recently in the fact that the actual HIV infections were not as high as estimated in early 2007 by some international agencies. But complacency would be disastrous, since each unaccounted for infection holds the potential of another. And at close to three million people living with HIV the number still is very high.

Information is really at the heart of the solution to prevent any new infections and to give people living with HIV a more fulfilling life inspite of and with the virus. With stigma and discrimination the core obstacles faced by most positive persons and their families, even the idea of getting tested comes with its own set of complications. Violence and ostracism become the social fallouts of this medical condition. Not only do widows of HIV-positive men get through out of their marital homes but children from households with an HIV-positive member have lower enrollment and higher drop out rates. Education should be the first line of defense against the spread of the virus but often educational access is compromised by the virus itself. Besides, for information to reach its intended audience what needs to be kept in mind is the large mass of the illiterate population. And hence dissemination of information through media resources other than the written one becomes absolutely imperative and using local tools like folk theatre, music, cinema, community gatherings, street plays and puppet shows probably would be more popular methods of ensuring attendance and acceptance.

But more than everything else, what is required is support from the government: support to make testing services more accessible for those willing and ensuring that government services themselves are not discriminatory to the infected persons and their families.

The danger with bills like the PEPFAR is that they do find support amidst the more conservative policy planners in the country — which is a dangerous trend when it comes to dealing with issues like HIV/AIDS. For instance, an earlier administration in India actually followed a deliberate policy of shifting focus of AIDS prevention campaigns to sexual abstinence and marital fidelity, relegating condoms to a distant third going so far as even removing condom advertisements from state-run television networks in the name of decency and to keep in line with their own orthodox policies. The irony is that in India the virus has confined itself to a sexual triangle of poor, male migrant workers, the sex workers they visit and the wives they leave back home. So any bill carrying provisions like the PEPFAR in effect excludes from its group of beneficiaries a substantial portion of the high risk populations in the country.

If HIV has been taken up as one of the most serious concerns of the 21st century, then to deny certain groups access to treatment and funds for treatment is an infringement on basic human rights. Universal access to HIV/AIDS treatment is the immediate need. Access to all kinds of healthcare invariably suffers from bureaucratic hiccups and to have an additional set of prerequisites before the treatment and care can be made available to the target groups is both inhuman and criminal. In its current stage the epidemic calls for streamlining not just government but extra national processes to be able to achieve universal access to lifesaving HIV/AIDS treatment, including access to second-line therapies if the fight against HIV has to be won both in terms of time and the number of people it reaches.