Matter of Life or Death India is the seventh largest Country in the world, home to one billion people and vast ethnic diversity. It has been making great leaps with education, industrialization and technology. Literacy rates are continuously going up along with life expectancy. India has been making continuous progress in many aspects for a country that has been relatively poor and extremely poverty-stricken. India is also one of the world’s largest democracies meaning that citizens have a great deal of political freedom.
The average Indian citizen lives in a rural area and consumes 30 times less resources than an American citizen consumes. Although India is making many improvements, there are certain issues that continue to creep around and into the lives of Indian people and will continue to do so for a very long time. HIV/AIDS is one of these issues, an issue that has been taking millions of lives and affecting the lifestyles of many Indian people. HIV/AIDS is one of the most concerning problems for India; it continues to manifest regardless of the many efforts made by the Indian government.
HIV/AIDS is not just a problem that India must deal with; it has affected nearly every region in the world but every country and population responds to epidemics with a different approach and one must consider all the different aspects. In India, many unique factors have been linked with the growth, prevention and treatment of HIV/AIDS. The causes for the emergence of HIV/AIDS in India are still unclear however; some believe that foreign visitors that had sexual contact with the sex workers in India are to blame. Many believe this because initial cases were found in sex worker and truck drivers.
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HIV/AIDS emerged into India later than most other countries and the first cases were reported in Chennai, Tamil Nadu. Studies also indicate that heterosexual sex was the method in which most initial cases occurred through. It was first identified in the early 80’s in sex workers from Tamil Nadu. The infection rates of the disease peaked in the early 90’s and it had made its way into low – risk individuals across the whole country in just ten years. (Avert, 2011) The most recent estimates state that there are currently 2. million individuals living with HIV in India and of that, 39% are females and 3. 5% are children. Considering age as a factor, the highest infection rates occur in people aged 30-34 in India. HIV rates for the nation have been decreasing according to recent studies (NACO, 2007) and the area of southern India which was impacted the most by this epidemic has shown a decrease in infection rates (Kumar R. , Jha P. et al. , 2006). Seventy percent of infections are reported in six states: Andhra Pradesh, Tamil Nadu, Maharashtra, Manipur, Nagaland and Karnataka.
Currently the state of Andhra Pradesh holds the highest prevalence rate (1%) out of the 28 states and out of the high-risk groups in this Andhra Pradesh; the highest rate is among MSM (17%) (Avert, 2011). In recent years the rate of injection drug users has been increasing in many states and has given HIV an opportunity to spread. One of these states are Punjab in the northeast of India where a third of the population is addicted to drugs and has become one of the world’s leading areas in drug trafficking and usage (Glut, 2011). In the Punjab’s capital city Amritsar, the prevalence rate among IDU’s is as high as 30%.
In many states of India drug use has become another concerning phenomenon that is helping with the spread of HIV/AIDS. Although the nation’s prevalence rates of HIV have decreased, it does not mean that the situation is getting better. This disease will continue to claim millions of lives because India does not have the equipment or resources needed in most areas; along with that the taboos, and stigma in India will negatively affect the treatment and prevention of HIV/AIDS. The way that Indians think about HIV/AIDS plays a major role in treatment and prevention efforts.
There are many parts of the world where one with HIV/AIDS is able to go to a doctor, friend or family member to get support. In India, this is not the case for the most part. It is a country with a strict social hierarchy and most Indian people still believe in arranged marriages. The people of India stigmatize HIV/AIDS, which often leads to discrimination, denial, humiliation and rejection from family/community and medical staff. HIV/AIDS is not just any disease in India, since it is linked to controversial behaviours HIV/AIDS comes with a lot more baggage than for instance cancer does.
HIV/AIDS is extremely under reported due to the many psychological hardships one must face in order to get the help that they need. Currently 50% of people with HIV are aware of their status; people that seek treatment often face traumatizing experiences with the medical staff. The government of India supports voluntary testing however, a very high percentage of cases have been reported in which the patient had been tested against their will, which in return would dictate the quality of medical care they would receive.
In many cases, individuals have been denied medical services because of their status and people that are HIV+ and belong to a high-risk group face double the discrimination and stigma because they are a part of a controversial group. There is a direct correlation with Indian culture and the identification of HIV/AIDS in India. In order to successfully educate and treat the Indian population we must take into account the very sensitive cultural values of Indian people and customize action plans accordingly. Sex in India is highly discouraged amongst non-married couples and the topic is hushed.
Indians greatly value marriage and hold the lowest divorce rate in world (Divorce Mag, 2011). Woman are seen as disgraceful, worthless and disgusting if they engage in sex with a partner before marriage and in most cases are disowned or face harsh consequences for their actions from family members and other social groups. For Indian people it is ideal to have and maintain one sexual partner although woman in India face double standards while men are able to participate in sexual intercourse with multiple partners there for the HIV status of women is highly dependent on the behaviour of their partner(s)/spouse.
The taboo of talking about sex publically and sex in general is the main reason for the hardships faced by educators, organizations and other public figures who try to make efforts with the awareness of HIV/AIDS. India is a place where a bar can possibly be shut down if any public display of affection is shown. There can be many explanations for the way Indian people think about sex that date back to the history of the first civilizations and religious texts that may have influenced and shaped the ideology of Indian people today.
This is a way of thinking that has existed in India for thousands of year and will continue to do so for a very long time. Education and communication is extremely difficult in a place where the population is not willing to listen, Indian people tend to ignore and underestimate HIV/AIDS because they are unwilling to talk about it. Most Indian people are unaware of the facts that in return cause them to link it to unacceptable behaviours creating stigma, discrimination and denial due to lack of knowledge.
People are hesitant to expose their HIV status and discuss issues with people. HIV/AIDS has claimed many lives in India, more so then many other parts of the world. The world fact book estimated 170 000 deaths in the year 2009 (ranked third highest in the world). Causality rates of HIV/AIDS related deaths have been decreasing in recent years. Many efforts have been made to prevent the spread of the disease by the government and other organizations yet India ranks as one of the top countries on HIV/AIDS hit list.
The people of India have a hard time explaining and discussing the impact that HIV/AIDS has left on their country. People often are surprised and thrown off when they are presented with actual statistics, they see the disease as someone else’s problem with the attitude that it is a disease that infects the “scum of society” but once they are presented with the statistics they are immediately appalled. Indian youth is continuously encouraged to ignore such topics and refrain from talking about sex by their families.
Another interesting issue is the misleading statistics that the government of India presents which understates the real statistics, Indian people lose trust in the government and don’t know which statistics to believe (Drynan, 2001). Indian people that live in poor areas with very low income believe that the spread of infection is mainly because a family member has to migrate to another location for a long period of time to find work and make an income to support his/her family. Since the majority of the population in India is poor, this is the leading explanation that most families will have.
Indian people that are HIV + believe that the spread of the disease is linked to the decision of keeping HIV statuses a secret. Some sex workers admit that they do not expose their status to clients in fear of losing their job. Indian people are aware that health care systems need to improve in order to stop HIV/AIDS from spreading. There also a large portion of people who believe in fate and that if someone is infected with HIV/AIDS it is in their fate to die that way. “In the past I never thought that I would contract such a big disease, or neither would my husband.
I had that much faith in him because we wouldn’t do such things. Now I don’t talk to my husband, I don’t know his whereabouts. God gave me this disease, what God metes out, Only God can judge. I have a daughter who is HIV + as well. I feel bad that my child has it but what can one do. I have a lot of problems at work, my co-workers tease me and shun me. They do not come near me” Anita who is HIV+ explained her thoughts about her status (Lets Break Through, 2006). Since the creation of antiretroviral therapy (ART/ARV) many lives have been extended and maybe even saved.
In India these drugs are becoming more available and the price of these drugs is declining as time goes by how ever not everyone has access to these drugs. Many areas of India where these drugs are needed are poor areas where Doctors refuse to practise due to lack of income available. Many villages do not have access to someone who can administrate these drugs. The main factor is money, these drugs are expensive and many families simply cannot afford them. Recently the government has been focusing on distributing free antiretroviral drugs but it is impossible to reach everyone in need with the available funds.
India is also actively manufacturing generic low-cost ARV’s. Out of all the people that need treatment only ? are receiving it (Avert, 2011) and many are not adhering due to high costs of drugs/testing, poor counselling, inadequate understanding and intolerance to drugs. Treatment centres are located in every state where HIV/AIDS is prevalent, screening is voluntary (ideally) and counselling is provided. The types of screening available are: Western blot test, ELISA, viral load test, CD4 count and blood biochemistry.
Luckily India has a strong pharmaceutical industry and is taking advantage of it by reaching out to its patients. Another issue is drug resistant people; in Mumbai 18% of newly diagnosed people were resistant to at least one drug (World Bank, 2011) so second-line therapy is required. Another concerning problem is that therapy in India is unstructured. Although these drugs are becoming more available in India, those in need are often denied access by the health care providers. The poor are ignored and usually do not have the funds or the resources to obtain the drugs. HIV/AIDS Treatment and Prevention in India, 2011) Some other popular alternative traditional therapy in India includes Chinese medicine, Homeopathy, acupuncture and siddha medicine (Life Positive, 2011).
The impact that HIV/AIDS will have on India in the future may be devastating if the current trends do not change. Treatment needs to be made more available, Health care providers need to be trained adequately and the general population needs to be educated. Many organizations and government have helped with the control of this epidemic such as promoting condom use are making improvements. Condoms are now used among many sex workers who ecite the policy of “no condom, no sex” to their customers and this is important because as of today condoms are the single most convenient and effective way of preventing the transmission of sexually transmitted diseases. There is no doubt that India is putting resources towards organizations that will provide services for the Indian population but this alone is not enough, Indian people themselves will need to accept and face this issue in order to make progress. Since India has a large portion of High-risk groups, there is always going to be danger and opportunity for HIV/AIDS to spread.
The rates vary from state to state but World Banks estimates that by 2033 mortality by infectious diseases will increase and of that, AIDS will represent 22% of total deaths. India has economic, cultural and other demographic factors that hamper prevention efforts. Discrimination, denial and stigma will continue to cause damaged relationships, torn families, physical isolation, desertion, economic implications, lower quality of life and death. This disease will continue to control the lives of people that are infected.
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