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December 2004 - January 2005


HIV/AIDS in India

By Aishwarya Rai, a former Miss World, who has won many ‘best actress’ awards for her Bollywood roles and last year was the first Indian actor to be a member of the jury at the Cannes Film Festival. She is currently starring in Bride and Prejudice opposite Martin Henderson

India is on the move, its economy growing rapidly. The gleaming buildings of its vibrant corporations scrape the sky in its burgeoning cities, while its universities turn out some of the best engineers and doctors in the world. Such signs of progress indicate India’s efforts to overcome its development challenges. Although it struggles to educate the millions who cannot read and to provide better livelihoods for its citizens who have to survive on less than $1 per day, there is a powerful sense of energy as its people look to the future. My work as an actress has taken me across India and I have seen the challenges and felt the energy. But I have also seen a new and grave threat to the ability of my country to achieve its vast potential – the threat of HIV/AIDS.

At an AIDS support centre operated by Freedom Foundation, a private charity in Bangalore, the beautiful brown eyes of Rajni (not her actual name), a young Indian mother, look into a bleak future. Married at 14, she became a widow at 20 when her husband, who ran a small business, died of AIDS – and she tested positive for HIV. As she watches her 12-year-old son, also HIV-positive, play in the courtyard, she speaks sadly of her healthy nine-year-old daughter, given to her sister so that she does not have to bear the stigma of the disease. She speaks of a supportive extended family, but frowns as she describes how the cost of her husband’s medical care forced her family to sell its home and condemned 24 relatives to poverty.

More than 5.1 million people in India are infected with HIV – 500,000 more than at the end of 2002. Indeed, the country now has the second highest number of cases in the world. The disease is already present in all 35 states and some experts expect as many as 15 million people could have the virus by the end of this decade unless decisive action is taken. By 2010, an estimated 2 million Indians will die of AIDS if nothing is done to stop the impending epidemic. Unless we act now, AIDS will ravage India as it has many countries in Africa, reducing life expectancies in some nations from 60 years to less than 40 and setting economic development back by decades.

Unfortunately, the widespread ignorance and stigma associated with AIDS hampers efforts to prevent the spread of the disease. Lack of education about its nature and causes leaves some people still believing that AIDS can be contracted from a mosquito bite or from shaking hands with an infected person, and others not realizing the dangers of indiscriminate and unprotected sexual activity. Much of the publicity about AIDS creates the impression that only marginalized elements of society – such as sex workers and drug abusers – are in danger from the disease: nothing could be further from the truth.

AIDS can affect everyone. It is spreading rapidly through India’s general population in both rural and urban areas: they have some 60 per cent and 40 per cent of the infected population respectively. One third of HIV-positive people are women: more than 75 per cent of AIDS infections result from heterosexual intercourse, mostly between husband and wife.

The increase of AIDS in women – the ‘feminization of AIDs’ – is particularly tragic because their lack of power and security means that they can do little to protect themselves from infection by their husbands, who have usually contracted the disease through sexual activity outside marriage. Widespread ignorance results in women being infected without recognizing the danger. Their low status, and the stigma of AIDS, makes them afraid to go to medical practitioners for help, and their poverty often puts treatment out of reach. Rajni’s eyes light up in anger as she speaks of other female clients at the centre who were forced to discontinue treatment, or had their drugs preempted, by their husbands or families.

Population increase, illiteracy, lack of information, stigma and discrimination, poverty, migration, lack of openness about sex, and inadequate health expenditures are the main factors that fuel the AIDS epidemic in India. They promote denial and fear, perhaps the two greatest obstacles to overcoming the threat. But there are signs of hope. India’s new prime minister, Dr Manmohan Singh, is calling for social reform to fight gender and class inequalities that promote the spread of AIDS. The government has initiated a surveillance system to test for HIV/AIDS at 450 sites across the country. Awareness levels are slowly rising as leaders across the political spectrum recognize the need to unite in their efforts to fight the disease.

Victory in the battle against AIDS will require an attack from all sides. Awareness campaigns can overcome denial. Advocacy efforts designed to promote better awareness of the causes of the disease – as well as of the fact that everybody is at risk – can reduce the stigma associated with it. The attack on AIDS cannot be separated from the issues of poverty and human rights. Advocating safe sexual practices will have no effect unless the rights of women are strengthened and respected. Prevention strategies will have little effect, and there will be little incentive to report infection, unless there are links to treatment that provides hope to the afflicted. Treatment, in turn, cannot be separated from efforts to improve livelihoods, as anti-retroviral drugs can be harmful to an empty stomach.

India need not fight this battle alone, and it can certainly learn from successful efforts elsewhere in the world. Preventing an AIDS epidemic will require effective partnerships. In the Bellary district outside Bangalore, Karnataka, and in five other states, an example exists of partnership between these states, the central Government, the United Nations system and NGOs that has begun to reduce women’s vulnerability by raising awareness of their reproductive health and rights. It also seeks to empower them to negotiate sexual relations and to increase their access to reproductive health services and information.

The CHARCA (Coordinated HIV/AIDS Response through Capacity Building and Awareness) initiative – jointly financed by the United Nations Foundation and the Government of the Netherlands – focuses on women and girls aged between 13 and 25. It will engage communities and empower women through community-based organizations such as Freedom Foundation in collaboration with female elected village officials. The CHARCA project is one of the first district-wide interventions for young women in the general population. It is working towards creating an environment that fosters equality and ensures justice for women and girls, seeking to equip them both to protect themselves against the virus and to realize their rights.

In spite of her condition, Rajni is hopeful. She is one of the fortunate ones with access to treatment. She is amazingly calm. Asked why, she says: ‘I have faith in my country. We will find a way to address AIDS. If I am not saved, at least my daughter will not have to suffer as I have suffered.’ We must keep faith with her and the millions of victims of the disease in India and worldwide and each do our part, however small, to make a difference.

Courtesy ‘OUR PLANET’

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