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HIV/AIDS In INDIA |
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It started with one documented case - a prostitute in Chennai. The year was 1986. Today, 21 years later, the number of HIV/AIDS infected Indians is in the millions. Government estimates peg the number of AIDS infected at around 5 million, but unofficial estimates by some NGO groups peg the number to be much higher than that. In any case, the unsavory distinction of having the largest number of AIDS infected belongs to India. A study conducted by the US spy organization, the CIA, says that in next 5 years the number of AIDS infected in India could go up to 25 million, which is more than the entire population of many European countries.
The HIV epidemic marches across India in many different ways. There is heterosexual transmission by prostitutes and migrant workers, especially truck drivers who drive on longer routes. It is quite common for prostitutes to have their brothels close to roadside dhabas frequented by truckers. When the truckers stop at these dhabas for food, they usually end up having sex too. In fact, the much-publicized kiss that Richard Gere planted on Shilpa Shetty's cheek happened at an AIDS awareness campaign held to educate truck drivers about the risks involved in unprotected sex. But in the hoopla over the kiss, the campaign against AIDS was all but forgotten. Doctors and drug users also contribute to the transmission of HIV when they use un-sterilized needles. |
The view has started gaining currency that the HIV situation in India might as well blow up into a crisis of global ramifications. With the scorching pace at which the disease is progressing in India, it is only a question of time before it starts affecting the global availability of treatment resources. More HIV drugs in India, means there will be fewer drugs to send to Africa, which is a much poorer place. Peter Piot, head of UNAIDS, the UN's program on HIV/AIDS, suggests that without adequate intervention, the AIDS situation in India, China and Russia will simply blow up into unmanageable proportions and that could send the world economy into a fatal tailspin. According to UNAIDS over 12 million AIDS related deaths can occur in India between 2000 and 2015, about 50 million can be expected between 2015 and 2050 (well over 1 million per year).
Peter Piot makes a frightening analogy to prove his point. He takes the rapid spread of HIV in South Africa as a model for the potential spread of the disease in India. In South Africa, the prevalence of HIV/AIDS moved from 0.5% of the population to 1% over five years. Over the next seven years, that proportion grew dramatically to an astonishing 20%. Today the AIDS prevalence rate in India is approaching 1%, and if the South African model were to hold true, we might be in for a similar tipping point, where almost 20% Indians could become HIV positive within the next seven years. Clearly, in dealing with the AIDS epidemic there is no room for complacency. With so much poverty, illiteracy and uneducated people, checking the spread of HIV is a daunting task.
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People need to be educated about the ways in which they can prevent the spread of the disease. The AIDS awareness campaign launched by Richard Gere and Shilpa Shetty was a good idea, but in the end those two film stars ended up teaching the nation how to kiss in public. Their message about AIDS awareness was lost in the glitzy display of their pecking and kissing. Some initiatives by the government to rein in the disease have had mixed results. Soon after the first cases were documented, India established HIV screening centers that focused first on foreigners, especially students coming from Africa. Later on the government started screening the blood banks to prevent the supply of infected blood.
The National AIDS Control Program, launched in 1987, is responsible for surveillance, screening, and health education for the disease. The National AIDS Control Organization (NACO), established in 1992, is another bureaucratic organization engaged in formulating national policies regarding AIDS. Then there is the Governmental Strategic Plan for AIDS Prevention, which is responsible for the running of AIDS-focused organizations in 25 states. An outreach program made considerable progress for prostitutes in Kolkata. When this health education program was launched in 1992, only 27% of the sex-workers reported using condoms; by 1995 the proportion had more than tripled, to 82%. Similar programs targeting the truck drivers of the country have also been launched. The drivers are provided with free condoms. |
NACO has also launched national HIV awareness campaigns through music concerts, radio programs, and celebrity spokespeople (e.g., Bollywood stars). But most of these star studded shows fail to deliver the message. The Bollywood stars capture all the hype and the AIDS message gets lost in the midst of their shenanigans. The diversity of language in the country also proves to be a barrier in spreading awareness about the disease. People who are not fluent in any particular language are not able to fully comprehend the campaign crafted in that language. Another pitfall is the age-old Indian sense of stigma associated with any sex related disease. People are not open about their disease, they prefer to rot and die in the privacy of their homes.
Despite AIDS being a catastrophic disease, it is surprisingly easy to prevent. The simplest method to combat HIV is condom use. In India, about 1 billion condoms get manufactured but only 25% of these reach the people who plan to use the products as intended. The remainder are purchased in bulk by companies and used in the manufacture of toys and clothing (e.g., to polish the gold embroidery of saris) or in construction- related work (e.g., condoms are mixed into road-paving because they expand with heat and prevent seepage). It is strange that more condoms are used for purposes that have nothing to do with sex. At times, men and women intentionally decide not to use condoms. Both genders may see condom use as unromantic - "He doesn't really love me if he has to use that." A condom usage might also be taken as a sign of mistrust or even the acknowledgment of sex-related disease.
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However, the greatest challenge for India in combating HIV is a subtler, more insidious one – the idea of denial. According to Richard Holbrooke, head of the Global Business Coalition on HIV/AIDS, despite India's major economic progress, the country is in denial mode about the AIDS crisis, due mostly to the unwillingness of many political leaders to recognize the problem's extent. Indians are not\ supposed to be sexually promiscuous people, so how can AIDS spread in India - that is the sort of hypocritical reasoning that motivates these politicians acknowledging the threat of AIDS. Indira Gandhi's disastrous forced-sterilization policies of the 1970’s have contributed in making the public suspicious of government programs that have anything to do with sex.
Due to these political reasons the HIV-related initiatives in the country remain woefully under-funded. For example, NACO's most recent five-year budget was just over $300 million, less than 3% of the funds set aside for military purposes. But NACO's lack of budgetary muscle may also be attributed to the general Indian trend of being frugal in the department of public health care. In fact, India's health-related spending is less than 2% of its GDP, one of the lowest in the world. As far as the politicians in the country are concerned, they had made it amply clear that the HIV crisis is for them is at best a low-priority issue.
In 2001, the government adopted the National AIDS Prevention and Control Policy. During that year, Prime Minister Atal Bihari Vajpayee addressed the parliament and referred to HIV/AIDS as one of the most serious health challenges facing the country. The Prime Minister also met the chief ministers of the six high-prevalence states to plan the implementation of strategies for HIV/AIDS prevention. If not much has been achieved by this initiative; it is a lack of political will that is to blame. The popular notion is that the only people who die of AIDS are those who are promiscuous by nature, who might be of gay sexual orientation, and those who take drugs. The moral climate in the country does not expect the politicians to care about such people.
So we can't expect much help from Indian political organizations and we can't expect help from foreign countries either. India is not a focus of President Bush's $15 billion Emergency Plan for AIDS Relief, which has most of the funds earmarked for African countries. Randall Tobias, the director of Bush's foreign policies on AIDS, has gone on record saying, "[Indians] have the capacity to do a great deal for themselves." There is no doubt that India does have the capacity to do a lot, but how does one translate the inherent capacity into an efficient execution that can achieve results? Until existing and new efforts to control HIV gain traction in India, the disease will continue to spread, a growing, oozing sore on the country's rosy face of economic progress.
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