| In Focus |
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 The HIV Problem
Let’s talk about it – we need to
HIV/AIDS is causing untold human suffering and, in many countries, is reversing decades of developmental progress. Since the late 1970s, more than 23 million people have lost their lives to the disease and by 2010, the cumulative toll is expected to rise to 45 million. After more than 30 years of the earliest-known cases, many people around the world still remain uniformed. In many countries, indigenous traditions and cultures are not conducive to facing up to the taboo surrounding sex and sexuality.
Neck Deep and Still Sinking: The Numbers
With more than a billion people, India is one of the most populated and largest countries in the world. New statistics from the National AIDS Control Association (NACO) indicate that 2.5 million people are currently living with HIV and AIDS. After the first AIDS cases were diagnosed in India in 1986, all states started to report an increasing number of people living with HIV and AIDS (PLWHA).
If one looks at the numbers, there is diversity in spread based on geographical location. The southern parts of the country and the far north-east are more affected by HIV. The highest numbers of HIV infection are reported in the south (Andhra Pradesh and Karnataka), in the west (Maharashtra) and in the north-east (Manipur and Nagaland). The numbers continue to increase and most infected people are in the economically productive 15-49 age group (88.7 percent of all infections), which has significant implications on the country’s economy and society as a whole.
Also, the disease is clearly having an impact on all segments of Indian society—not only sex workers and truck drivers as often falsely presumed. PLWHAs come from different cultures, backgrounds and lifestyles. It is important to bear in mind that the vast majority of HIV infections in India occur through heterosexual intercourse.The infection rate among men is considerably higher but the number of infected women is rising. (For every 100 PLWHAs, 61 are men and 39 are women.) While the general public continues to believe that most women with HIV/AIDS are sex workers, official numbers indicate that women in monogamous relationships form a large percentage of females infected in India. There has also been an increase in cases of HIV among housewives and solvent members of society (previously considered as ‘low-risk’). In many cases, women in monogamous relationships are infected through their husbands having multiple sexual partners.
Walking the Tightrope: ‘High Risk’ Groups
Sex workers, injecting drug users, truck drivers, migrant workers and men who have sex with men are considered ‘high risk’ groups. But it is important to remember that membership to a particular group is, in itself, not risky. Risk is determined by what a person does and his or her behavior. Let’s take a closer look at the different high-risk behaviour groups:
Many sex workers enters the industry as a result of poverty and their dire circumstances make it hard for them to negotiate condom use with clients. They are often uneducated, even illiterate, and unaware of HIV or what they need to do to prevent it. Some are forced into prostitution at a young age and are scarcely in a position to demand anything in the oppressive market they find themselves in. A substantial number of sex workers in Mumbai, Mysore and Karnataka are affected by HIV/AIDS and usually, the disease may be traced to their lack of awareness about condom usage or their inability to insist on clients using condoms. Disturbingly, in a recent study in Mysore, 91 percent of sex workers stated that they had never used a condom.
Transmission through injecting drug use another major factor, particularly in the north-eastern states and in the metropolitan cities of Delhi, Chennai, Mumbai and Chandigarh. Orissa, Punjab, West Bengal, Uttar Pradesh and Kerala also show high prevalence of HIV among Injecting Drug Users.
With one of the largest road networks in the world, India has millions of truck drivers who spend long periods of time on the road. Their lives are tough and lonely with many hours spent away from home and many frequent sex workers. Most are unwilling to use condoms or do not know how to use them. Often, they remain unaware even after contracting the disease. They continue to move from state to state functioning as highly mobile carriers of the disease.
Similar factors come into play with migrant workers who move from town to town in search of work. Often, they travel to places where there is a high prevalence of the disease—unknowingly or because they do not have a choice in terms of livelihood. Each state (and even particular regions within states) has its own distinct cultural identity and language. Obviously, linguistic and cultural barriers also work against accessing relevant information about sexual health.
Young people are more vulnerable to sexually transmitted diseases than adults. Gender imbalances, societal norms and economic dependence contribute to this risk. Lack of access to correct information (around 73% of young people have misconceptions about HIV transmission), a tendency to experiment and the hush around sexuality adds to their vulnerability. Young women are biologically more vulnerable to HIV infection than young men—a situation that is aggravated by their inadequate access to information and complete lack of power over their sexual lives. Early marriage also poses special risks to young people, particularly women, and this is especially relevant in a country where almost 50 percent of girls are married off by the time they turn 18.
Adding Insult to Injury – The Terrible Stigma
The HIV/AIDS epidemic is stigmatized and misunderstood and often connected with fear and myth among the general public. PLWHAs have often been rejected by their spouses, families or communities; faced violent attacks; been refused medical treatment; and even denied last rites. Outreach workers and peer educators routinely face harassment from the police and the general public. Teachers have to deal with negative reactions from parents of children when they try to teach them about AIDS. Discrimination is also common in the health sector where negative attitudes from health care staff have projected anxiety among many PLWHW. As a result, many PLWHAs keep their HIV positive status secret.
Discrimination and stigma create barriers to spreading awareness, and therefore, make it harder to prevent further infection. Accurate information is an important tool and by silencing open discussion, such attitudes pose a huge challenge to preventing the spread of disease. They also make it impossible to adequately provide PLWHAs with care, support and treatment.
The impact of HIV needs to be viewed not just in terms of the numbers infected and directly affected by HIV, but also the resources available to cope with the situation at the family, community and national level because AIDS affects multiple aspects of our social, economic, political and religious life. It challenges the well-being of family life and the growth of the community. It cripples other developmental efforts by constantly chipping away at the progress made in other directions such as poverty reduction. Above all, it is a threat to human dignity.
The culture of silence that surrounds HIV/AIDS is caused because of a mistaken association with “immorality” in the form of certain sexual behaviors, alcohol and drug abuse but this silence has devastating effects. A UNICEF report states: Where people with HIV are stigmatized, they often remain silent out of fear. They tend not to seek support that could help them lead fuller, healthier lives or the information they need to prevent the spread of HIV to others. Moreover, where there is silence about the social and sexual issues that fuel the epidemic (including sex as a survival strategy and violence against women and girls, including rape and child abuse), people will continue to remain ignorant, powerless, exploited and silent. We need to break this silence by acknowledging suffering and reaching out with compassion to the people who are rejected. It is time to end denial, guilt, stigma and discrimination and make the way towards knowledge, reconciliation, prevention, care, healing and, most importantly, hope.
Sources:
AVERT(International AIDS charity): www.avert.org
ACET international: www.acet-international.org
Break Through: http://www.breakthrough.tv/index.asp
Grassroots Tool kit for HIV and AIDS, Responses to common questions (Kenya: A Daystar University Publication, 2005)
Happonen O. Hannu, Opportunity in crisis. Basic Lessons on HIV and AIDS.
National AIDS Control Organisation: www.naco.org
UNAIDS: www.unaids.org
UNICEF: www.unicef.org
UNICEF: What Religious Leaders Can do About HIV and AIDS (New York, 2003)
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