Current Status of Indian Women

India: An Overview
India, with a population of 989 million, is the world's second most populous
country. Of that number, 120 million are women who live in poverty. India
has 16 percent of the world's population, but only 2.4 percent of its land,
resulting in great pressures on its natural resources.
Over 70 percent of India's population currently derives their livelihood from
land resources, which includes 84 percent of the economically-active women.
India is one of the few countries where males significantly outnumber
females, and this imbalance has increased over time. India's maternal
mortality rates in rural areas are among the world's highest. From a global
perspective, Indian accounts for 19 percent of all lives births and 27 percent
of all maternal deaths.
"There seems to be a consensus that higher female mortality between ages
one and five and high maternal mortality rates result in a deficit of females
in the population. Chatterjee (1990) estimates that deaths of young girls in
India exceed those of young boys by over 300,000 each year, and every
sixth infant death is specifically due to gender discrimination." Of the 15
million baby girls born in India each year, nearly 25 percent will not live to
see their 15th birthday.
"Although India was the first country to announce an official family planning
program in 1952, its population grew from 361 million in 1951 to 844 million
in 1991. India's total fertility rate of 3.8 births per woman can be considered
moderate by world standards, but the sheer magnitude of population
increase has resulted in such a feeling of urgency that containment of
population growth is listed as one of the six most important objectives in the
Eighth Five-Year Plan." Since 1970, the use of modern contraceptive
methods has risen from 10 percent to 40 percent, with great variance
between northern and southern India. The most striking aspect of
contraceptive use in India is the predominance of sterilization, which
accounts for more than 85 percent of total modern contraception use, with
female sterilization accounting for 90 percent of all sterilizations.
The Indian constitution grants women equal rights with men, but strong
patriarchal traditions persist, with women's lives shaped by customs that are
centuries old. In most Indian families, a daughter is viewed as a liability, and
she is conditioned to believe that she is inferior and subordinate to men.
Sons are idolized and celebrated. May you be the mother of a hundred sons
is a common Hindu wedding blessing.
The origin of the Indian idea of appropriate female behavior can be traced to
the rules laid down by Manu in 200 B.C.: "by a young girl, by a young
woman, or even by an aged one, nothing must be done independently, even
in her own house". "In childhood a female must be subject to her father, in
youth to her husband, when her lord is dead to her sons; a woman must
never be independent."
A study of women in the Swayam Shikshan Prayog (SSP), based in 20 villages
in four districts in Maharashtra state was introduced in this way:
The primary issue all women in the SSP were struggling with was that of
everyday survival. Insufficient incomes and the lack of employment were
reported to be their most pressing concerns. Survival is a constant
preoccupation and at its most basic, survival means food (Chambers 1983).
The most common problems were the lack of basic amenities such as food,
water, fuel, fodder and health facilities. In addition, the deterioration of the
natural environment and the fact that many of their traditional occupations
were no longer viable were conditions that were making it increasingly hard
for women to continue sustaining their families, as they had done in the past.
SSP is a loose, informal network of women's collectives, voluntary
organizations, action groups and unions.

Women condition in India

According India’s constitution, women are legal citizens of the country and
have equal rights with men (Indian Parliament). Because of lack of
acceptance from the male dominant society, Indian women suffer
immensely. Women are responsible for baring children, yet they are
malnourished and in poor health. Women are also overworked in the field
and complete the all of the domestic work. Most Indian women are
uneducated. Although the country’s constitution says women have equal
status to men, women are powerless and are mistreated inside and outside
the home.

India is a society where the male is greatly revered. Therefore women,

especially the young girls, get very little respect and standing in this country.
The women of the household are required to prepare the meal for the men,
who eat most of the food. Only after the males are finished eating, can the
females eat. Typically the leftover food is meager, considering the families
are poor and have little to begin with. This creates a major problem with
malnutrition, especially for pregnant or nursing women. Very few women
seek medical care while pregnant because it is thought of as a temporary
condition. This is one main reason why India’s maternal and infant mortality
rates are so high. Starting from birth, girls do not receive as much care and
commitment from their parents and society as a boy would. For example a
new baby girl would only be breast fed for a short period of time, barely
supplying her with the nutrients she needs. This is so that the mother can
get pregnant as soon as possible in hopes of a son the next time.
Even though the constitution guarantees free primary schooling to everyone
up to 14 years of age (Indian Parliament), very few females attend school.
Only about 39 percent of all women in India actually attend primary schools.
There are several reasons why families choose not to educate their
daughters. One reason is that parents get nothing in return for educating
their daughters. Another reason is that all the females in a household have
the responsibility of the housework. So even though education does not
financially burden the family, it costs them the time she spends at school
when she could be doing chores. In addition, even if a woman is educated,
especially in the poorer regions, there is no hope for a job. Most jobs women
perform are agricultural or domestic which do not require a formal
education. Another reason girls are not educated is because families are
required to supply a chaste daughter to the family of her future husband.
With over two-thirds of teachers in India being men and students
predominately male, putting daughters in school, where males surround
them all day could pose a possible threat to their virginity.
Because women are not educated and cannot hold a prestigious job,
they take on the most physically difficult and undesirable jobs. A typical day
for a woman in an agricultural position lasts from 4am to 8pm with only an
hour break in the middle. Compared to a man’s day, which is from 5am to
10am and then from 3pm to 5pm. Most women are overworked with no
maternity leave or special breaks for those who are pregnant. Plus women do
the majority of the manual labor that uses a lot of energy compared to the
men who do mostly machine operating.
Even though women work twice as many hours as men, the men say
that “women eat food and do nothing.” This is mainly because the work the
women perform does not require a lot of skill and are smaller tasks

Chronic Hunger and the Status of Women in India

The persistence of hunger and abject poverty in India and other parts of the
world is due in large measure to the subjugation, marginalization and
disempowerment of women. Women suffer from hunger and poverty in
greater numbers and to a great degree than men. At the same time, it is
women who bear the primary responsibility for actions needed to end
hunger: education, nutrition, health and family income.
Looking through the lens of hunger and poverty, there are seven major areas
of discrimination against women in India:

Malnutrition: India has exceptionally high rates of child malnutrition,

because tradition in India requires that women eat last and least throughout
their lives, even when pregnant and lactating. Malnourished women give
birth to malnourished children, perpetuating the cycle.

Poor Health: Females receive less health care than males. Many women die
in childbirth of easily prevented complications. Working conditions and
environmental pollution further impairs women's health.

Lack of education: Families are far less likely to educate girls than boys,
and far more likely to pull them out of school, either to help out at home or
from fear of violence.
Overwork: Women work longer hours and their work is more arduous than
men's, yet their work is unrecognized. Men report that "women, like children,
eat and do nothing." Technological progress in agriculture has had a
negative impact on women.

Unskilled: In women's primary employment sector - agriculture - extension

services overlook women.

Mistreatment: In recent years, there has been an alarming rise in atrocities

against women in India, in terms of rapes, assaults and dowry-related
murders. Fear of violence suppresses the aspirations of all women. Female
infanticide and sex-selective abortions are additional forms of violence that
reflect the devaluing of females in Indian society.

Powerlessness: While women are guaranteed equality under the

constitution, legal protection has little effect in the face of prevailing
patriarchal traditions. Women lack power to decide who they will marry, and
are often married off as children. Legal loopholes are used to deny women
inheritance rights.
India has a long history of activism for women's welfare and rights, which
has increasingly focused on women's economic rights. A range of
government programs have been launched to increase economic opportunity
for women, although there appear to be no existing programs to address the
cultural and traditional discrimination against women that leads to her abject
conditions.

Indian women beating:

The Unicef report titled 'Progress for Children' surveyed households in 67
countries to determine attitudes towards domestic violence When asked
their opinion, on an average, half of the girls and women aged 15-49
responded that a husband or partner is justified in beating his wife under
certain circumstances. The study was carried out between 2001-07.
According to Unicef, approval of wife-beating varied significantly depending
on the level of education. Less educated women are more likely to feel that
a husband is justified in hitting or beating his wife. As with the level of
education, wealth quintile and area of residence appear to influence
significantly women's approval of wife beating. Overall, women from rural
areas are women belonging to the poorest quintile of wealth distribution and
are more likely to justify wife-beating than women from urban areas and
women of the richer households. In India, there has been an alarming rise in
the atrocities committed against women, the report pointed out.

While the Constitution guarantees equal opportunity, patriarchy asserts itself

through legal loopholes to consolidate the age-old domination. A range of
government programs have been launched to increase economic opportunity
for women, although there appears to be no existing program to address the
cultural and traditional discrimination against women.
Domestic violence affects women's wellbeing and the health, nutrition and
education of children who experience it as well as children who witness it. In
the context of gender inequality, women's response to abuse reflects their
relatively fewer options to change or leave the relationship and their
assessment of how best to protect themselves and their children. Ending
domestic violence requires changing attitudes that permit such abuse,
developing legal and policy frameworks to prohibit and reject it, and
improving women's access to economic resources and girls' access to
education, the Unicef report said.
India is one of the largest and most populated countries in the world, with
over one billion inhabitants. Of this number, it's estimated that around 2.27
million people are currently living with HIV. HIV emerged later in India than it
did in many other countries. Infection rates soared throughout the 1990s,
and today the epidemic affects all sectors of Indian society, not just the
groups – such as sex workers and truck drivers – with which it was originally
associated.
In a country where poverty, illiteracy and poor health are rife, the spread of
HIV presents a daunting challenge.

The History of HIV/AIDS in India

At the beginning of 1986, despite over 20,000 reported AIDS cases
worldwide, India had no reported cases of HIV. There was recognition,
though, that this would not be the case for long, and concerns were raised
about how India would cope once HIV and AIDS cases started to emerge. One
report, published in a medical journal in January 1986, stated:
“Unlike developed countries, India lacks the scientific laboratories, research
facilities, equipment, and medical personnel to deal with an AIDS epidemic.
In addition, factors such as cultural taboos against discussion of sexual
practices, poor coordination between local health authorities and their
communities, widespread poverty and malnutrition, and a lack of capacity to
test and store blood would severely hinder the ability of the Government to
control AIDS if the disease did become widespread.” Later in the year, India’s
first cases of HIV were diagnosed among sex workers in Chennai, Tamil
Nadu. It was noted that contact with foreign visitors had played a role in
initial infections among sex workers, and as HIV screening centers were set
up across the country there were calls for visitors to be screened for HIV.
Gradually, these calls subsided as more attention was paid to ensuring that
HIV screening was carried out in blood banks.

In 1987 a National AIDS Control Program was launched to co-ordinate

national responses. Its activities covered surveillance, blood screening, and
health education. By the end of 1987, out of 52,907 who had been tested,
around 135 people were found to be HIV positive and 14 had AIDS. Most of
these initial cases had occurred through heterosexual sex, but at the end of
the 1980s a rapid spread of HIV was observed among injecting drug users
(IDUs) in Manipur, Mizoram and Nagaland - three north-eastern states of
India bordering Myanmar (Burma).
At the beginning of the 1990s, as infection rates continued to rise, responses
were strengthened. In 1992 the government set up NACO (the National AIDS
Control Organization), to oversee the formulation of policies, prevention work
and control programs relating to HIV and AIDS. In the same year, the
government launched a Strategic Plan, the National AIDS Control Program
(NACP) for HIV prevention. This plan established the administrative and
technical basis for program management and also set up State AIDS Control
Societies (SACS) in 25 states and 7 union territories. It was able to make a
number of important improvements in HIV prevention such as improving
blood safety.

World Aids Day in India, December 2004.

By this stage, cases of HIV infection had been reported in every state of the
country. Throughout the 1990s, it was clear that although individual states
and cities had separate epidemics, HIV had spread to the general population.
Increasingly, cases of infection were observed among people that had
previously been seen as ‘low-risk’, such as housewives and richer members
of society. In 1998, one author wrote:
“HIV infection is now common in India; exactly what the prevalence is, is not
really known, but it can be stated without any fear of being wrong that
infection is widespread… it is spreading rapidly into those segments that
society in India does not recognize as being at risk. AIDS is coming out of the
closet.”
In 1999, the second phase of the National AIDS Control Program (NACP II)
came into effect with the stated aim of reducing the spread of HIV through
promoting behavior change. During this time, the prevention of mother-to-
child transmission (PMTCT) program and the provision of free antiretroviral
treatment were implemented for the first time. In 2001, the government
adopted the National AIDS Prevention and Control Policy and former Prime
Minister Atal Bihari Vajpayee referred to HIV/AIDS as one of the most serious
health challenges facing the country when he addressed parliament.
Vajpayee also met the chief ministers of the six high-prevalence states to
plan the implementation of strategies for HIV/AIDS prevention.
The third phase (NACP III) began in 2007, with the highest priority to reach
80 percent of high-risk groups including sex workers, men who have sex with
men, and injecting drug users with targeted interventions. Targeted
interventions are generally carried out by civil society or community
organizations in partnership with the State AIDS Control Societies. They
include outreach programs focused on behavior change through peer
education, distribution of condoms and other risk reduction materials,
treatment of sexually transmitted diseases, linkages to health services, as
well as advocacy and training of local groups. The NACP III also seeks to
decentralize the HIV effort to the most local level, i.e. districts, and engage
more nongovernmental organizations in providing welfare services to those
living with HIV/AIDS.

Current estimates
In 2006 UNAIDS estimated that there were 5.6 million people living with HIV
in India, which indicated that there were more people with HIV in India than
in any other country in the world. In 2007, following the first survey of HIV
among the general population, UNAIDS and NACO agreed on a new estimate
– between 2 million and 3.1 million people living with HIV.
In 2008 the figure was confirmed to be 2.31 million, which equates to a
prevalence of 0.3%. While this may seem a low rate, because India's
population is so large, it is third in the world in terms of greatest number of
people living with HIV. With a population of around a billion, a mere 0.1%
increase in HIV prevalence would increase the estimated number of people
living with HIV by over half a million.
The national HIV prevalence rose dramatically in the early years of the
epidemic, but a study released at the beginning of 2006 suggests that the
HIV infection rate has recently fallen in southern India, the region that has
been hit hardest by AIDS In addition, NACO released figures in 2008
suggesting that the number of people living with HIV has declined from 2.73
million in 2002 to 2.27 million in 2008.

Some AIDS activists are doubtful that the situation is

improving:
“It is the reverse. All the NGOs I know have recorded increases in the number
of people accepting help because of HIV. I am really worried that we are just
burying our head in the sand over this.” Anjali Gopalan, the Naz Foundation,
Delhi
Peter Piot, Executive Director of UNAIDS, stresses:
“The statement that India has the AIDS problem under control is not true.
There is a decline in prevalence in some of the Southern states… In the rest
of the county, there are no arguments to demonstrate that AIDS is under
control”
For more detailed information on HIV prevalence and AIDS deaths, see our
HIV and AIDS statistics for India.
The HIV/AIDS situation in different states

Map of India showing the worst affected states.

The vast size of India makes it difficult to examine the effects of HIV on the
country as a whole. The majority of states within India have a higher
population than most African countries, so a more detailed picture of the
crisis can be gained by looking at each state individually.
The HIV prevalence data for most states is established through testing
pregnant women at antenatal clinics. While this means that the data are only
directly relevant to sexually active women, they still provide a reasonable
indication as to the overall HIV prevalence of each area.
The following states have recorded the highest levels of HIV prevalence at
antenatal and sexually transmitted disease (STD) clinics over recent years.

Andhra Pradesh
Andhra Pradesh in the southeast of the country has a total population of
around 76 million, of whom 6 million live in or around the city of Hyderabad.
The HIV prevalence at antenatal clinics was 1% in 2007. This figure is smaller
than the reported 1.26% in 2006, but remains the highest out of all states.
HIV prevalence at STD clinics was very high at 17% in 2007. Among high-risk
groups, HIV prevalence was highest among men who have sex with men
(MSM) (17%), followed by female sex workers (9.7%) and IDUs (3.7%).
Goa
Goa, a popular tourist destination, is a very small state in the southwest of
India (population 1.4 million). In 2007 HIV prevalence among antenatal and
STD clinic attendees was 0.18% and 5.6% respectively. The Goa State AIDS
Control Society reported that in 2008, a record number of 26,737 people
were tested for HIV, of which 1018 (3.81%) tested positive.

Karnataka
Karnataka, a diverse state in the southwest of India, has a population of
around 53 million. HIV prevalence among antenatal clinic attendees
exceeded 1% from 2003 to 2006, and dropped to 0.5% in 2007. Districts with
the highest prevalence tend to be located in and around Bangalore in the
southern part of the state, or in northern Karnataka's "devadasi belt".
Devadasi women are a group of women who have historically been
dedicated to the service of gods. These days, this has evolved into
sanctioned prostitution, and as a result many women from this part of the
country are supplied to the sex trade in big cities such as Mumbai. The
average HIV prevalence among female sex workers in Karnataka was just
over 5% in 2007, and 17.6% of men who have sex with men were found to
be infected.

Maharashtra
Maharashtra is a very large state of three hundred thousand square
kilometers, with a total population of around 97 million. The capital city of
Maharashtra - Mumbai (Bombay) - is the most populous city in India, with
around 14 million inhabitants. The HIV prevalence at antenatal clinics in
Maharashtra was 0.5% in 2007. At 18%, the state has the highest reported
rates of HIV prevalence among female sex workers. Similarly high rates were
found among injecting drug users (24%) and men who have sex with men
(12%).

Tamil Nadu
With a population of over 66 million, Tamil Nadu is the seventh most
populous state in India. Between 1995 and 1997 HIV prevalence among
pregnant women tripled to around 1.25%. The State Government
subsequently set up an AIDS society, which aimed to focus on HIV prevention
initiatives. A safe-sex campaign was launched, encouraging condom use and
attacking the stigma and ignorance associated with HIV. Between 1996 and
1998 a survey showed that the number of men reporting high-risk sexual
behavior had decreased.
In 2007 HIV prevalence among antenatal clinic attendees was 0.25%. HIV
prevalence among injecting drug users was 16.8%, third highest out of all
reporting states. HIV prevalence among men who have sex with men and
female sex workers was 6.6% and 4.68% respectively.
Manipur
Manipur is a small state of some 2.4 million people in northeast India.
Manipur borders Myanmar (Burma), one of the world's largest producers of
illicit opium. In the early 1980s drug use became popular in northeast India
and it wasn't long before HIV was reported among injecting drug users in the
region. Although NACO report a state-wise HIV prevalence of 17.9% among
IDUs, studies from different areas of the state find prevalence to be as high
as 32%. HIV is no longer confined to IDUs, but has spread further to the
general population. HIV prevalence at antenatal clinics in Manipur exceeded
1% in recent years, but then declined to 0.75% in 2007. Estimated adult HIV
prevalence is the highest out of all states, at 1.57%.

Mizoram
The small northeastern state of Mizoram has fewer than a million
inhabitants. In 1998, an HIV epidemic took off quickly among the state's
male injecting drug users, with some drug clinics registering HIV rates of
more than 70% among their patients. In recent years the average prevalence
among this group has been much lower, at around 3-7%. HIV prevalence at
antenatal clinics was 0.75% in 2007.

Nagaland
Nagaland is another small northeastern state where injecting drug use has
again been the driving force behind the spread of HIV. In 2003 HIV
prevalence among IDUs was 8.43%, but has since declined to 1.91% in 2007.
HIV prevalence at antenatal clinics and STD clinics was 0.60% and 3.42%
respectively in 2007.

Punjab
The Punjab, a state in northern mainland India, has shown an increase in
prevalence among injecting drug users (13.8% in 2007) in recent years. One
of the richest cities in the Punjab, Ludhiana, has an HIV prevalence of 21%
among IDUs while the HIV prevalence among IDUs in the capital of the state,
Amritsar, has reached 30%. Denis Broun, head of UNAIDS in India has
stated…"the problem of IDUs has been underestimated in mainland India, as
most of the problem was thought to be in the northeast."

Who is affected by HIV and AIDS in India?

People living with HIV in India come from incredibly diverse cultures and
backgrounds. The vast majority of infections occurs through heterosexual
sex (80%), and is concentrated among high risk groups including sex
workers, men who have sex with men, and injecting drug users as well as
truck drivers and migrant workers. See our page on affected groups in India
for more information.
HIV prevention
Educating people about HIV/AIDS and how it can be prevented is complicated
in India, as a number of major languages and hundreds of different dialects
are spoken within its population. This means that, although some HIV/AIDS
prevention and education can be done at the national level, many of the
efforts are best carried out at the state and local level.
Each state has its own AIDS Prevention and Control Society, which carries
out local initiatives with guidance from NACO. Under the second stage of the
government’s National AIDS Control Program (NACP-II), which finished in
March 2006, state AIDS control societies were granted funding for youth
campaigns, blood safety checks, and HIV testing, among other things.
Various public platforms were used to raise awareness of the epidemic -
concerts, radio dramas, a voluntary blood donation day and TV spots with a
popular Indian film-star. Messages were also conveyed to young people
through schools. Teachers and peer educators were trained to teach about
the subject, and students were educated through active learning sessions,
including debates and role-play.

AIDS awareness banners in Sangli, India - 2005

The third stage of the National AIDS Control Program (NACP-III), was
launched in July 2007 and runs until 2012. The program has a budget of
around $2.6 billion, two thirds of which is for prevention and one sixth for
treatment. Aside from the government, this money will come from non-
governmental organizations, companies, and international agencies, such as
the World Bank and the Bill and Melinda Gates Foundation.
As part of its focus on prevention, the government has supported the
installation of over 11,000 condom vending machines in colleges, road-side
restaurants, stations, gas stations and hospitals. With support from the
United States Agency for International Development (USAID), the
government has also initiated a campaign called ‘Condom Bindas Bol!’
(Condom-Just say it!), which involves advertising, public events and celebrity
endorsements. It aims to break the taboo that currently surrounds condom
use in India, and to persuade people that they should not be embarrassed to
buy them.

In one unique scheme, health activists in West Bengal promoted condom use
through kite flying, which is popular before the state’s biggest festival, Durga
Puja:
"The colorful kites carry the message that using a condom is a simple and
instinctive act… they can fly high in the sky and land at distant places where
we cannot reach." -
This initiative is an example of how HIV prevention campaigns in India can be
tailored to the situations of different states and areas. In doing so, they can
make an important impact, particularly in rural areas where information is
often lacking. Small-scale campaigns like this are often run or supported by
non-governmental organizations, which play a vital role in preventing
infections throughout India, particularly among high-risk groups. In some
cases, members of these risk groups have formed their own organizations to
respond to the epidemic.

The government has however funded a small number of national campaigns

to spread awareness about HIV/AIDS to complement the local level
initiatives. On World AIDS Day 2007 India flagged off its largest national
campaign to date, in the form of a seven-coach train called the 'Red Ribbon
Express.' A year later the train journey was completed, having travelled to
180 stations in 24 states and reaching around 6.2 million people with
HIV/AIDS education and awareness. Following the success of the campaign,
the 'Red Ribbon Express' took off again in December 2009, and now includes
counseling and training services, HIV testing, treatment of sexually
transmitted diseases (STDS) as well as HIV/AIDS education and awareness.
According to a mid-year report on the progress of the second round of the
Red Ribbon Express, NACO estimates that 3.8 million people were reached in
the first six months of the campaign. According to NACO the 'response has
been overwhelming', with queues of people waiting to access the services a
common sight, and follow up surveys indicating that knowledge of
transmission routes of HIV and prevention methods have increased
significantly in the areas visited by the train.
PMTCT
In 2004 only 5% of pregnant women living with HIV received antiretroviral to
prevent mother-to-child transmission. By 2007 this had risen to 14% but with
such low coverage 21,000 children below the age of 15 are still infected
every year through mother-to-child transmission in India. According to the
National AIDS Control Organization, only a third of all estimated HIV positive
mothers were reached with PMTCT services in 2009.

Testing
The general consensus among those fighting AIDS worldwide is that HIV
testing should be carried out voluntarily, with the consent of the individual
concerned. This view has been supported by the Indian government and
NACO, who have helped to establish hundreds of integrated counseling and
testing centers (ICTCs) in India. By the end of 2009 there were 5135 ICTCs in
India, compared to just 62 in 1997. By 2009 these centers tested had tested
13.4 million people for HIV, an increase from 4 million in 2006.

Health Clinic near Sangli, India - 2005

Although voluntary testing is officially supported in India, some states have
tried to implement policies that would force people to be tested for HIV
against their will. In Goa and Andhra Pradesh the state governments
proposed a bill in 2006 to make HIV tests compulsory before marriage, and
in Punjab it has been proposed that all people wishing to obtain or retain a
driver’s license should be tested for HIV. Neither of these plans has come to
pass, but they have concerned activists, who argue that HIV testing should
never be imposed on people against their wishes.
Unfortunately, cases of people being tested without their consent or
knowledge are common in Indian hospitals. In one 2002 study, it was
suggested that over 95% of patients listed for surgical procedures are tested
against their will, often resulting in their surgery being cancelled. Hospital
staff and health professionals, much like the rest of the Indian population,
are often unaware of the facts about HIV. This leads to unnecessary fears
and, in some cases, causes them to stigmatize HIV positive people and
discriminate against them, including testing them without consent.
India has certainly made progress in expanding HIV testing to its large
population. However, considering only 50% of those currently infected with
HIV are aware of their status there is still significant work to be done in this
area.

Treatment for people living with HIV

Antiretroviral drugs (ARVs), which can significantly delay the progression
from HIV to AIDS – have been available in developed countries since 1996.
Unfortunately, as in many resource-poor areas, access to this treatment is
limited in India; an estimated 300,000 adults (aged 15 and above) were
receiving free ARVs by April 2010. This represents less than half of the adults
estimated to be in need of antiretroviral treatment in India.
While the coverage of treatment remains unacceptably low, improvements
are being made. The government has started to expand access to ARVs in a
number of areas; by
November 2009 there were 266 reported sites providing antiretroviral
therapy.
Increasing access to ARVs also means that an increasing number of people
living with HIV in India are developing drug resistance. When HIV becomes
resistant to the ARVs the treatment regimen needs to be changed to
'second-line' ARVs. As with many other parts of the world, second-line
treatment in India is far more expensive than first-line treatment.
In 2008, NACO began to roll out government funded second-line
antiretroviral treatment in two centers in Mumbai and Chennai. By 2009
second-line therapy was available in a total of eight states but treatment
remains very limited. Of the 3,000 who need to be on second line treatment,
about 970 were receiving it as of January 2010. One reason for this is
expense; second line ARV drugs, unlike first line ARVs, are not produced on a
large scale in India due to patent issues that control drug pricing and can be
more than 10 times more expensive than first line ARVs. Another reason why
coverage is so limited is the eligibility requirements imposed on second line
ARVs; only those 'living below the poverty line, widows and children' and
those who have received first-line ARVs from a government centre for at
least two years are eligible.
Ironically, India is a major provider of cheap generic copies of ARVs to
countries all over the world. However, the large scale of India’s epidemic, the
diversity of its spread, and the country’s lack of finances and resources
continue to present barriers to India’s antiretroviral treatment program.
To read about the challenges faced in increasing access to antiretroviral
drugs around the world, see our Universal access to AIDS treatment page.

Stigma and discrimination in India

In India, as elsewhere, AIDS is often seen as “someone else’s problem” – as
something that affects people living on the margins of society, whose
lifestyles are considered immoral. Even as it moves into the general
population, the HIV epidemic is still misunderstood among the Indian public.
People living with HIV have faced violent attacks, been rejected by families,
spouses and communities, been refused medical treatment, and even, in
some reported cases, denied the last rites before they die.

A schoolteacher fired after testing HIV-positive Is embraced by daughter As

well as adding to the suffering of people living with HIV, this discrimination is
hindering efforts to prevent new infections. While such strong reactions to
HIV and AIDS exist, it is difficult to educate people about how they can avoid
infection. AIDS outreach workers and peer-educators have reported
harassment, and in schools, teachers sometimes face negative reactions
from the parents of children that they teach about AIDS:
“When I discussed with my mother about having an AIDS education program,
she said, ‘you learn and come home and talk about it in the neighborhood,
they will kick you’. She feels that we should not talk about it.” Female
student, Chennai
Discrimination is also alarmingly common in the health care sector. Negative
attitudes from health care staff have generated anxiety and fear among
many people living with HIV and AIDS. As a result, many keep their status
secret. It is not surprising that for many HIV positive people, AIDS-related
fear and anxiety, and at times denial of their HIV status, can be traced to
traumatic experiences in health care settings.
"There is an almost hysterical kind of fear ... at all levels, starting from the
humblest, the sweeper or the ward boy, up to the heads of departments,
which make them pathologically scared of having to deal with an HIV positive
patient. Wherever they have an HIV patient, the responses are shameful." -
A 2006 study found that 25% of people living with HIV in India had been
refused medical treatment on the basis of their HIV-positive status. It also
found strong evidence of stigma in the workplace, with 74% of employees
not disclosing their status to their employees for fear of discrimination. Of
the 26% who did disclose their status, 10% reported having faced prejudice
as a result. People in marginalized groups - female sex workers, hijras
(transgender) and gay men - are often stigmatized not only because of their
HIV status, but also because they belong to socially excluded groups.
Stigma is made worse by a lack of knowledge about AIDS. Although a high
percentage of people have heard about HIV and AIDS in urban areas (94% of
men and 83% of women) this is much lower in rural areas where only 77% of
men and 50% of women have heard of HIV and AIDS. However, the real
challenge lies with ignorance about how HIV is transmitted - for example the
majority of men and women in rural areas believe that AIDS can be
transmitted by mosquito bites. In 2009, NACO carried a population based
survey in Nagaland, which showed that 72.8% of people believed HIV could
be transmitted by sharing food with someone.
To learn more about the way that prejudice is hindering the global fight
against AIDS.

The future of HIV and AIDS in India

HIV/AIDS information painted on a wall in Darjeeling, India various groups
have made predictions about the effect that AIDS will have on India and the
rest of Asia in the future, and there has been a lot of dispute about the
accuracy of these estimates. For instance, a 2002 report by the CIA's
National Intelligence Council predicted 20 million to 25 million AIDS cases in
India by 2010 - more than any other country in the world. India's government
responded by calling these figures completely inaccurate, and accused those
who cited them of spreading panic. The government has also disputed
predictions that India’s epidemic is on an African trajectory, although it
claims to acknowledge the seriousness of the crisis. Indeed, recent surveys
do suggest that national HIV prevalence has probably fallen slightly in recent
years. This trend is mainly due to a drop in infections in southern states; in
other areas there has been no significant decline.
“In the north-east, the dual HIV epidemic driven by unsafe sex and injecting
drug use is highly concerning. Moreover, there are many areas in the
northern states where HIV is increasing, particularly among injecting drug
users.” Sujatha Rao, Director General of NACO
HIV spending increased steadily in India from 2003 to 2007 but has since
fallen. In 2006-2007 $171 million was spent to contain and prevent the
growth of HIV, which represented an increase of 28% from the previous year.
Currently, India spends about 5% of its health budget on HIV and AIDS.
However, the World Bank has warned that India will have to scale up
prevention efforts in order to avoid spending more of its health budget in the
future. According to the World Bank’s report, by 2020 India will have to
spend 7% of its health budget on AIDS if the rising tide of the AIDS epidemic
in New Delhi, Mumbai, the north and the north east is not halted. This would
put further strain on a struggling health sector which, on top of HIV and AIDS,
faces a growing multitude of health challenges including malaria, diabetes,
heart disease and cancer. Yet, in 2008-2009 spending on HIV/AIDS fell by
15% to $146 million.
Even if the country's epidemic does not match the severity of those in
southern Africa, it is clear that HIV and AIDS will have a devastating effect on
the lives of millions of Indians for many years to come. It is essential that
effective action is taken to minimize this impact.
“The challenges India faces to overcome this epidemic are enormous. Yet
India possesses in ample quantities all the resources needed to achieve
universal access to HIV prevention and treatment… defeating AIDS will
require a significant intensification of our efforts, in India, just as in the rest
of the world” Peter Piot, former Executive Director of UNAIDS.

Indian Women's Health Still on the Downward Trend:

Report
Indian women have taken big steps in politics and the workforce but their
health
is still determined by class and caste, says a major study tracking their
experiences over the last 30years. Food shortages and a declining
government commitment to health care in the 1990s increased the
"systemic inequities" for women throughout the country, said a copy of the
report obtained by AFP. Positive developments such as longer female life
expectancy are negated by the fact that a woman's health
"Depends on where she is born and lives, and what class and caste she
belongs to," says the study.
The report, the first ever comprehensive review of the welfare of women at a
national level, was prepared over four years as part of a joint project
between the UN Development Program and the Ministry of Women and Child
Development. It used a landmark 1975 report on the status of women to
measure changes and maps their "intellectual and material contribution" to
society. Urvashi Butalia, the director of Zubaan books, which is publishing
the report in January, told AFP that it "balances gains and losses" on issues
such as globalization that have had both negative and positive impacts on
India. Although globalization has increased poverty for some, Butalia said it
has also created jobs in the service sector for lower- and middle-class women
who would otherwise be unable to find work.