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HIV/AIDS

OVERVIEW

According to India’s National AIDS Control Organization (NACO), the 2006 estimates suggest national adult HIV prevalence in India is approximately 0.36 percent, amounting to between 2 and 3.1 million people. If an average figure is taken, this comes to 2.5 million people living with HIV and AIDS in India.

Globally, nearly 33.2 million people are now estimated to be living with HIV/AIDS.

More men are HIV positive than women. Nationally, the prevalence rate for adult females is 0.29 percent, while for males it is 0.43 percent. This means that for every 100 people living with HIV and AIDS (PLHAs), 61 are men and 39 women. Prevalence is also high in the 15-49 age group (88.7 percent of all infections), indicating that AIDS still threatens the cream of society, those in the prime of their working life.

The northeastern states (Manipur, Mizoram and Nagaland) and the southern states (Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu) have the highest HIV prevalence; moreover, several new areas with high HIV prevalence are detected in other parts of the country.

With a population of more than one billion, low overall prevalence of HIV among the general population of India masks differences among regions, states and sub-populations. The 2006 estimates indicate that the epidemic has stabilized or seen a 

drop in Tamil Nadu and other southern states with a high HIV burden. Yet, new areas have seen a rise in HIV prevalence, particularly in the northern and eastern regions. Twenty-six districts have been identified with high prevalence, largely in the states of Madhya Pradesh, Uttar Pradesh, West Bengal, Orissa, Rajasthan and Bihar.

Overall, HIV prevalence is higher among urban than rural populations. However, some states have a slightly higher HIV prevalence among rural populations than urban populations, namely, Punjab, Tamil Nadu and Uttar Pradesh.

If nothing changes, the numbers of people affected by HIV/AIDS in India and around the world will continue to rise. But it doesn’t have to be that way. HIV is preventable. UNAIDS and the World Health Organization estimate as many as two-thirds of the more than 20 million new infections projected to occur globally in next five years could be avoided with increased awareness and prevention efforts.

For more information about HIV/AIDS in India and around the world log on to:

  1. www.nacoonline.org
  2. www.unaids.org
  3. www.globalhealthreporting.org
  4. www.kff.org

HIV/AIDS Facts

  1. There is no cure for HIV/AIDS
  2. NACO estimates that in 2004, 5.134 million people in India were affected by AIDS
  3. 85% of these were infected by a partner of the opposite sex
  4. The virus has started to spread form high-risk groups to the general population and to move from urban to rural areas. Maharashtra, Tamil Nadu, Manipur, Andhra Pradesh, Karnataka and Nagaland identified as high-risk states
  5. Nine out of 10 HIV positive people in India are between 15 and 44, the most economically productive age group
  6. 1.9 million women in India are HIV positive
  7. 22% of these are housewives with a single partner (Heffernan G. 2004)
  8. 300,000 children in the age group 0-14 are HIV positive (NACO: 2004)

HIV/AIDS Staying Safe

  1. Choose not to have sex; or make an agreement with a partner who is HIV negative to be sexually faithful to each other, and stick to it. If you or your partner is HIV positive, talk with your health care provider about how to reduce your risk, including using condoms or dental dams.
  2. Always use a condom for vaginal or anal sex, and barrier methods, such as a condom or dental dam for oral sex.
  3. If you are HIV positive and pregnant, see your health care provider to get appropriate treatment. Treatments are available to significantly reduce the risk of passing HIV to your child during pregnancy and delivery.
  4. Do not share needles or syringes for any kind of injection drug use.
  5. Ask partners to do the same.

HIV/AIDS - Getting Tested

HIV/AIDS Treatment

Presently, there is no cure or immunization against HIV. But there are new treatments available that can help HIV positive people to live longer and healthier lives and also delay the onset of AIDS.

The Treatment options depend on the kind of STD: bacterial, parasitic or viral. While bacterial and parasitic are easily cured with medications prescribed by a doctor, viral infections such as HIV, while not curable, can be treated. With these kinds of infections, medications can help to control some of the symptoms, even though there is no cure. However, viruses can still be spread even without symptoms.
Regardless of the type of STD, it is important that both the infected person and his or her partner receive treatment so that they do not re-infect each other. For those with HIV, early treatment and regular monitoring by a doctor can help to prevent opportunistic infections from occurring and treat them if they do occur, and delay the onset of AIDS.

HIV/AIDS Stigma Discrimination

In India, the social reaction to people living with HIV/AIDS has been overwhelmingly negative. The lack of awareness of the disease and societal inhibitions have led to it being perceived to be a disease of ‘others’, rampant amongst people living on the margins of society whose lifestyles are considered to be ‘perverted’ and ‘sinful’.
 
Factors which contribute to HIV/AIDS related stigma:
HIV/AIDS is an incurable disease
Association of the disease with presumed deviant behavior (such as sex between men, visiting sex workers and injecting drug-use)
Religious or moral beliefs, more so in India, that lead some people to believe that having HIV/AIDS is the result of moral fault (such as promiscuity or ‘deviant sex’) that deserves to be punished
 
Discrimination, stigmatization and denial are the outcome of a lack of awareness affecting life in families, communities, workplaces, schools and health care settings. HIV/AIDS related discrimination contributes to a large extent in ensuring the lack of appropriate policies and models of good practice. People living with HIV/AIDS continue to be burdened by poor care and inadequate services, whilst those with the power to help do little to make the situation better.
 
The health care sector has been contradictorily the most obvious context for HIV/AIDS related discrimination, stigma and denial. Negative attitudes from health care staff have generated anxiety and fear among many people living with HIV/AIDS. As a result, many keep their status secret, fearing still worse treatment from others. It is not surprising that among a majority of HIV positive people, AIDS-related fear and anxiety, and at times denial of their HIV status, can be traced to traumatic experiences in health care settings. There have been umpteen cases in India of HIV positive patients in India having to bear with a sign placed on their beds at hospitals announcing their HIV status.
 
Children of HIV positive parents too are forced to face discrimination irrespective of their HIV status. They are quite often denied the right to go to school or are kept in isolation from other children. Women too are blamed by their in-laws for being carriers of the disease and affecting their husbands irrespective of what the truth may be. People in marginalized groups (female sex workers, hijras [transgendered], gays and lesbians) are often stigmatized on the grounds of not only their HIV status but also for being members of socially excluded groups. The law of the land also looks down on them thus adding to their woes.
 
Stigma is also affecting prevention efforts, with the harassment of AIDS outreach workers and peer educators being reported. Although the Indian government encourages NGOs to provide condoms and AIDS education to high-risk groups such as sex workers and men who have sex with men, it seemingly allows law enforcement agencies to harass outreach workers who provide those services.
 

HIV/AIDS India Responds

Government

Taking note of the rise in HIV/AIDS cases in the country, in 1986, the Government of India established a National AIDS Control Program under the Ministry of Health and Family Welfare. Program activities covered surveillance, screening of blood and blood products and health education.
The National AIDS Control Organization (NACO) was created in 1992 in association with the World Bank in an attempt to coordinate an enhanced program of preventive activities. The Organization played a key role in providing national leadership and facilitating the development of State AIDS Societies in all states across India.
The challenge for NACO however, has been to sustain the momentum and keep pace with the rapid growth in the number of infections happening in the country. To this end, the Government has sought increased commitment from states, more effective and efficient partnerships between the public sector and NGOs, donors and the international health community.
The Government also announced the National AIDS Policy and National Blood Policy after a series of consultations with various stakeholders (NGOs, donors, people living with HIV/AIDS, civil society, and other partners). These policies provide the necessary framework for strengthening national and state level response.
 
India’s plan focuses first and foremost on prevention. Its operational objective is:
To contain HIV prevalence at 3% in states with a generalized epidemic, 2% in those with a concentrated epidemic and 1% in the rest of the country
Increase awareness to 90% among youth and other vulnerable parts of the population
Provide anti retroviral therapy (ARV) to HIV +ve new parents, infected children under age 15 and patients coming in to government hospitals in high-risk states
The National AIDS Prevention and Control Policy also recognizes the need to take care of workers’ health & welfare, in the organized and unorganized sectors as well as the need to develop a multi-pronged response to HIV/AIDS in workplace.
 
Donors
India receives a lot of technical assistance and funding from a variety of UN partners and bilateral donors. Amongst these is the Gates Foundation which has committed US$100 million over 10 years to strengthen HIV preventions amongst mobile populations. It has devoted most of its resources to focused intervention in the six states with high HIV prevalence as well as along national highways in an effort to reduce HIV transmission among high-risk groups especially sex workers, their clients, and injecting drug users (IDUs); and to slow the spread of the epidemic into the general population.
These interventions are supplemented by advocacy, public education, and capacity-building.
 
NGOs
More than 600 NGOs are implementing various HIV/AIDS prevention and care activities specifically targeted at high-risk groups through activities funded by the Government and other donor partners.
For a more detail list, please see Women’s Feature Service.
 
Corporate
Nearly 90% of HIV/AIDS infections in India have been reported from the 15-49 age group: the most economically productive segment of society. HIV/AIDS has an intense negative impact on the workforce, business, individual workers and their families, as well as the economy at a macro level.
The business community has been using its personal and organizational skills, as well as local influences to reinforce the government and private efforts in the areas where businesses are located. Some of the businesses involved in Workplace Education are Tata, Godrej Industries, Colgate and CII.

HIV/AIDS India Responds

Whether you choose to have sex or not, it is important to be able to talk about sex. It can be uncomfortable to have conversations about sex, but it gets easier if you know the facts.
 
Bottom line: When it comes to sex, open and honest communication is essential with friends, health care providers, parents/family, and partner(s).
 
Talking With Your Partner
The best time to talk with a partner about HIV and other STDs is before you start having sex. If you are already in a sexual relationship, it is still better late than never. Tell your partner you want to talk about this topic so the two of you can be closer and worry less.
 
Get tested together. By knowing each other’s status, you will eliminate any uncertainty. If either one of you does have an STD/HIV, you will want to discuss how to prevent the other person from getting it. Your health care provider can help you answer these questions.
 
If a couple is open about safer sex and each person’s sexual history, they can create a stronger and safer relationship. If your partner is reluctant to talk about STDs and HIV/AIDS, you may want to start the discussion by saying that being open is a way for you each to express that you care about the other’s safety and health.
 
Talking With Your Health Care Provider
Some health care providers may not discuss HIV or other STDs with their patients. If your provider does not bring up the topic, you should!
 
Be prepared to be open about your sexual history, including sexual experiences, number of partners, methods of protection or contraception used, and drug use history.
 
You should also mention any bodily changes, including menstrual cycle changes, vaginal or penile discharge, genital discomfort, or genital skin changes. If you’re not open and honest with your provider, he/she will not be able to help you.
 
Questions for Your Health Care Provider
So, you’ve found a doctor, made an appointment and now, the big day is here. What should you do? Just follow the three Ts: Take control, trust and talk. Here are some topics to cover and tips for asking questions:
Write down a list of questions before you get to the doctor’s office. Be sure to note anything unusual such as painful areas and rashes, bumps or sores that won’t go away
Ask whether you should be tested for HIV and/or other STDs
Be honest about your sexual experiences, your lifestyle, and if you use protection
Ask about your provider’s policy on confidentiality if you are concerned about privacy
If something feels uncomfortable or confusing, you should always ask your health care provider: ‘Can you explain what is going on?’ or ‘Can you slow down, please?

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