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HIV /AIDS in India

The Acquired Immune Deficiency Syndrome is caused by a virus called HIV (Human Immune Deficiency Virus). It is a condition in which the built in defense system of the body breaks down completely. This phenomenon is gradual but ultimately leads to total depletion of a very important cell component of the immune mechanism. Thus those who are affected are unable to combat with common diseases including even mild infections since his/her immunity is knocked out and body resistance is reduced.

AIDS was recognized for the first time in the USA in 1981.In India it was identified in after 5 years in May 1986. In October 1985 the health authorities of the Government of India realizing the threat and spread of HIV and AIDS through the Indian Council of Medical Research organized the screening of high risk groups with the aim of finding out whether HIV infection has reached India. Among the states, Manipur stands first followed by Maharashtra and thirdly TamilNadu.

HIV is currently spreading in the world at the rate of one new infection every fifty seconds. The HIV/AIDS is not confined to any one class, community, religion, age-group, sex or profession, though according to the Indian Health Organization women and children are believed to be more prone to AIDS.

The HIV infection is spread over all religions and all groups.

HIV is an infectious disease but is not easily transmitted through the environment such as air, water, food etc. Therefore it is non-communicable disease.

However the main causes or the modes through which the virus enters the body are:

1. Sexual intercourse with an infected person. The virus transmission is facilitated when either partner has other sexually transmitted disease (STDs). Genital ulcers and other infections such as syphilis could act as co-factors, aiding and abetting the AIDS virus.

2. The second mode is through the transfusion of HIV infected blood or the blood products or through infected blood in needles, syringes and other such instruments. These include needles and syringes shared by intravenous drug users and those that are induced for injections without proper cleaning and sterilization.

3. The third way is the transmission from an infected mother to her newborn.

Although HIV has been detected in several body fluids, it is infectious mainly from blood, semen and vaginal secretions e.g. very few virus have been detected in saliva, tears and breast milk. One does not get AIDS by kissing, hugging, sharing food, bed linen, mosquitoes, living or working with infected persons. Only certain situations are likely to facilitate the spread of AIDS virus. Most important among these are those with risky life-styles or risk behavior.

A study conducted by the Directorate of Health Services, Manipur in 1991 pointed out that in the analysis of 6,680 specimens of HIV the highest risk factor (93.9%) in spreading HIV was found to be intravenous drug addicts followed by blood donors (2.93%) and homosexuals (2.61%){Health for millions, Vol XVII, No.4, New Delhi, and August 1991}.

We will now analyze the main sources of transmission of virus, i.e prostitutes, intravenous drug addicts, blood donors, pathological laboratories and mothers with HIV infection giving birth to children. Prostitutes or the sex workers are believed to be about 20 lakh and distributed over 817 red-light areas in different parts of India. This does not include those who operate from their homes or hotels. A large number of them are infected with out any access to health services like screening and getting counseling. They infect their clients and in turn also get infected by them.

According to one estimate the level of HIV infection escalated from 1% to 30% among the sex-workers in Mumbai in just three years from 1989-1991.Drug addicts who take drugs by injection carry the possibility of spreading the HIV infection through shared infected needles. The use of drugs is spreading among the students, industrial workers, truck drivers and people living in slums. A good number of drug-users gradually become so addicted that they started taking them by self-injection. Some-times same syringes are used by many drug-addicts increasing the possibility of spreading the HIV infection.

In Manipur where 40 to 50%of intravenous drug-users are HIV positive many of them are sent to jail in some cases even by their own parents. Blood donors too transmit the HIV infection. There are estimated to be 2000 blood banks in our country which supply about 20 lakh bottles of blood every year. Half of these blood banks are government banks and the remaining half is unlicensed.

There are many professional donors who are also drug addicts which in turn may be HIV positive. When their blood is transfused to the patients without proper testing the HIV is transmitted. The pathological laboratories too transmit the HIV virus when they supply blood without scientific testing. Pregnant women who are HIV positive transmit the virus to the new-born children. About 65% of the pregnant women remain anemic and require blood transfusion on the other hand some of the women get infected from their husbands.

The HIV/AIDS epidemic in India is a rapidly escalating crisis. The government's estimate that about 4 million persons in the country are HIV-positive is widely thought to understate the true figure. In several states of India, such as Maharashtra and Tamil Nadu, the epidemic has spread to the general population. The states that have not reported any HIV positive cases may be because of poor surveillance. It does not necessarily mean they are HIV-free. In Rajasthan 23,689 blood samples screened by the Rajasthan Medical and Health Department in six cities from August 1992 to August 1996 revealed 4.4% samples were HIV positive. An estimate by UNDP suggests that HIV/AIDS has reduced the annual growth rate of GDP per capita around the world by nearly 0.06%. In most severely affected areas the reduction in annual growth rate may be around 0.15%.

It is difficult to visualize the devastating effects of the pandemic in our lifetime and beyond. What initially appeared to be an illness confined to few homosexuals has affected millions of men, women and children worldwide. AIDS is not a just a health problem rather it is a societal problem with important social, cultural and economic dimensions. It threatens the basic social institutions at the individual, family and community levels. Its economic consequences are equally serious as it could claim up to half of the national expenditure for health if the needs of AIDS patients were to be met fully. AIDS attacks people in their economic and socially most productive years and those responsible for the support and care of others. Consequently when the earners are dead, they leave behind families without any source of livelihood. Thus not only the HIV infected people initially face emotional trauma and later on social isolation and in the last one or two years suffer from serious body problems but economically too they are shattered. The victims are sacked from their jobs, disowned by their families and communities rejected by their friends, refused treatment by doctors, turned down by schools, colleges, universities and even sometimes imprisoned and humiliated. Their families too suffer economically, psychologically and socially.

Programs that provide information, condoms and HIV testing to persons in high-risk groups are crucial to preventing the further spread of the disease. In its official policies and statements, the Indian government has recognized the importance of reaching out to women in prostitution and men who have sex with men as a central element of its HIV/AIDS response. The national AIDS program led by AIDS control society of India, funded largely through a $200 million World Bank loan, invests in programs that target persons in high-risk groups. Bill and Melinda Gates Foundation pledged international funding amounting to $ 200 million for combating the disease. Still the potential costs of fighting the disease are staggering. However the facilities available for the care of AIDS patients are woefully inadequate.

Some measures have been suggested by protecting and preventing the AIDS and HIV infection. The greatest need is to educate people to have safe sex by using condoms and avoiding multiple sexual partners. This is done through T.V, radio, newspaper and other mass media. It is also required to introduce awareness through course content in the educational institutions. The medical fraternity in our country is prejudiced about HIV/AIDS with the result that patients are denied admission in hospitals and neglected in treatment by not regularly visiting them in the isolation wards. This has resulted in panic reactions.

Such rejections are counter-productive. Effective strategies have to be designed and developed which can help the patients in overcoming fear and hysteria. Counseling families, neighborhoods and members of social-support networks is also an important need because eventually they have to bear a major responsibility for the sick and the survivors. The trained medical staff can impart information about AIDS to the patients and to their relatives. Since persons suffering from STDs are also a significant risk factor it is important to give high priority to the programmes for the prevention and control of STDs.The blood or blood products should be tested for HIV before transfusion. The HIV tests should be made free and confidential for persons who indulge in high-risk activities.

The medical staff should ensure the use of disposable syringes and other operation equipment. The condoms should be freely distributed and its use should be encouraged among the sex-workers who are the most vulnerable group. The drug-users should be persuaded away from using intravenous drug abuse. The voluntary organizations should help spread knowledge on AIDS to different vulnerable groups through innovative and community-based approaches.

Nongovernmental organizations working through peer educators with women in prostitution in India have had remarkable success in raising awareness of the basic facts of HIV transmission and AIDS care, promoting condom use, and, not least, empowering marginalized women to take into their own hands the struggle against HIV/AIDS. Thousands of cases of AIDS have been prevented by this work, some of which has been supported financially or in kind by the government. Indeed, the Indian government recognizes officially the effectiveness of peer education as a strategy, the importance of condom distribution in prevention of HIV transmission, and the need to work with women in prostitution.

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