Pathetic situation of a human being..........
This is an story regarding an old south indian actress Noor Nisha, who died in 2007. Just informing to all of you to inform the pathetic situation of a human being who was in a glamorous world.
Nisha also known as Noor Nisha was a popular South Indian actress. She mainly concentrated on Tamil and Malayalam films. She was popular for her roles in the films like Kalyana Agathikal (1986) and Iyer The Great (1990). She acted in several other films like Tick! Tick! Tick! (1981), the critically acclaimed Chuvappunaada, Mimics Action 500, Ilamay Idho Idho etc. She was on the peak of her career during 1980 to 1986. After she left the industry unnoticed. After her mother's death, she became orphan and she was at last found in a pathetic condition at the street and the Muslim Munnetta Kazhagam volunteers admitted her to Thambaram hospital near Chennai, India. There she was daignosed with AIDS. Later her health deteriorated and was struggling with diseases. She died in 2007.
Thambaram began treating HIV patients in the early 1990s, and since then has seen an exponential rise in the number of HIV admissions. They are currently diagnosing approximately 1000 new HIV cases each month. As a public hospital, Thambaram accepts all patients at no charge, despite extremely limited resources. Thambaram is treating the largest volume of HIV cases of any public hospital in India.The majority of the children seen in the pediatric ward at Thambaram Hospital are being treated for either HIV, Tuberculosis, or both, in this and a significant proportion are AIDS orphans.
any good medical for sex items like.............enlarging of...
Nic - I got ur point. In this case, she was diogonised very late.
- God Gives n Forgivs .. We Gets n Forgets -
yes phoenix2009 she was only 40yrs when she died.
wow she was only 40 when she died, what did she do to herself to die like this? on the streets? i guess she had had a hectic life of her own.
so sorry for her and her fans.
Its really very sad to see her like that
I am really sorry for what happened to her!
Nic...in some situations we can't do nothing,it's her fate. She left the film industry unnoticed and she was found in streets and the treatment only started after that, her condition had improved after admitting to the hospital. But her health deteriorated and died. Noone knows what hpnd to her earlier.
HIV, if treated before it becomes AIDS, does no longer kill and people can live a normal life for many years.
This lady, being an actress, had she lived in a more open society, she would have certainly seek treatment on time.
My point was that society’s taboos may encourage people to hide the disease before it reaches an advance stage that can no longer be controlled.
Even if they get treatment...the final stages will look similar to that picture...what if they are not diganosed till they got AIDs? Normal people dont do HIV test unless they have doubt..bcos of their immoral life..
Nic , read well wht you wrote. Whatevr treatment you give, the patient will look like this in the last stages of it. whethr in US or Congo.
- Listen to Many...Speak to a Few -
"Deaths of Persons with AIDS
In 2007, the estimated number of deaths of persons with AIDS in the United States and dependent areas was 14,561. In the 50 states and the District of Columbia, this included 14,105 adults and adolescents, and 5 children under age 13 years.
The cumulative estimated number of deaths of persons with AIDS in the United States and dependent areas, through 2007, was 583,298. In the 50 states and the District of Columbia, this included 557,902 adults and adolescents, and 4,891 children under age 13 years.
Totals include persons of unknown race or multiple races, persons of unknown sex, and persons of unknown state of residence. Because totals were calculated independently of the values for the subpopulations, subpopulation values may not equal the totals."
Source: Center for Desease control and prevention website
No, I am not saying that. Read again.
To help you understand my words:
The attached picture is from a person who didn't get HIV treatment or did get treatment like the one that was available in the 80's in my country!
Nic you saying that people dont die of AIDS in your country or in US??? get real dude!!
Unfortunately you are wrong! Why you write something that you don't really know as a fact?!
This is no old story nor was the actress old. The problem here is that she was in India. Had she left India and seek for treatment in the US or any other country with a similar development, she would probably still be alive, in good shape and making movies.
The pic you attached, says it all!
Qtel has banned this informative web site.
Life is short. Break all the rules. Forgive quickly.
Kiss slowly, love truly and never regret the things that
made you laugh.
Graduated from Xavier Institute for Higher learning
Who is affected by HIV and AIDS in India?
HIV and AIDS affect all segments of India’s population, from children to adults, businessmen to homeless people, female sex workers to housewives, and gay men to heterosexuals. There is no single ‘group’ affected by HIV. However, HIV prevalence among certain groups (sex workers, injecting drug users, truck drivers, migrant workers, men who have sex with men) remains high and is currently around 6 to 8 times that of the general population.
A general problem
It is thought that HIV has spread among the general population in India because the epidemic has followed what is know as the 'type 4' pattern.2 This is where new infections occur first among the most vulnerable populations (such as injecting drug users and female sex workers), then spread to 'bridge' populations (clients of sex workers and sexual partners of drug users) and then finally enter the general population.3
“The overwhelming majority of infections in India occur through heterosexual sex.”
In contrast to the common perception that HIV is transmitted predominantly through injecting drug use and sex between men, the overwhelming majority of infections in India occur through heterosexual sex;4 women now account for around 39% of adult infections.5 In many cases married men have acted as 'bridge populations' between vulnerable populations and general populations; women who believe they are in monogamous relationships are becoming infected because their husbands have had multiple sexual partners. Often social norms restrict women from making decisions about their sexual relations, contributing to their vulnerability to HIV.6 Studies have shown that intimate sexual partner violence is also a risk factor for women.7
Another significant trend is that most of the people becoming infected are in the sexually active and economically productive 15 to 44 age group. This means that most people living with HIV are in the prime of their working lives. Many are supporting families.
Sex work is very widespread in India, and occurs on a much larger scale than in many other countries. Women often get involved as a result of poverty, marital break-up, or because they are forced into it. Although sex work is not strictly illegal in India, associated activities - such as running a brothel – are. The government has plans to introduce stricter legislation in regard to sex work, a move that has been opposed by organised sex worker groups who claim that such legislation would just push the trade underground and make it harder to regulate.8 It would also make it more difficult to reach sex workers with information about HIV, at a time when misinformation about AIDS among this group is rife – for instance, one national study suggests that 42% of sex workers believe that they can tell whether a client has HIV on the basis of their physical appearance.
HIV prevalence among sex workers varies between districts and states, although there has been a general decline in prevalence in recent years.10 One study found prevalence ranged between 2 percent and 38 percent (averaging at 14.5 percent) among districts in the four high prevalence south Indian states Andhra Pradesh, Maharashtra, Tamil Nadu and Karnataka.11
In the city of Mysore, southern India, around a quarter of sex workers are infected with HIV.12 This situation is not surprising given that in one study only 20 percent of sex workers had always used condoms with commercial clients in the past month.13
One way in which authorities are trying to tackle the epidemic among sex workers in Mysore is through a ‘smart card’ scheme. Sex workers are provided with cards that contain their medical details, which must be presented at a health check-up at least once every three months to remain valid. On the condition that these appointments are attended, the card can be used to get discounts for food and clothes in certain shops. As well as encouraging sex workers to look after their health, this initiative raises sex worker’s self-esteem by integrating them into mainstream culture. In turn, this can help them to take a firmer stance on condom use when negotiating with clients.14
"Now the card-holders feel they are part of the mainstream. Their self-esteem has gone up." - Sushena Reza-Paul, Karnataka Health Promotion Trust15
Another positive initiative – possibly the most successful of its kind in India - has been the Sonagachi project, named after the district of central Kolkata (Calcutta) where it is based. This project was started in 1992, with the aim of reaching out to sex worker communities and helping them to overcome HIV on their own terms. Its approach is based around three R’s: Respect, Reliance and Recognition – respecting sex workers, relying on them to run the program, and recognising their professional and human rights. Sex workers have been trained to act as peer-educators, and sent to brothels to teach others about HIV and AIDS, and the importance of using condoms with clients. The campaign also addresses the social and practical barriers that prevent sex workers from using a condom. Madams and pimps are educated about the economic benefits of enforcing condom use in their brothels, and police have been persuaded to stop raiding brothels, because such raids often resulted in sex workers losing income, making them less likely to insist on condom use.16
“The Sonagachi project has become internationally famous for its achievements, and the UN has used the project as a ‘best practice’ model for other sex worker projects around the world.”
By helping to put sex workers in a position where they can respond to their own needs, the Sonagachi project has achieved impressive results. Between 1992 and 1995, condom use among sex workers rose from 27% to 82%. By 2001, it was 86%.17 The project continues to have an impact, with HIV prevalence among sex workers in the area falling from 11% in 2001 to less than 4% by 2004.18 The Sonagachi project has become internationally famous for its achievements, and the UN has used the project as a ‘best practice’ model for other sex worker projects around the world.19
A neglected group of people who may be at risk of HIV infection in India is male sex workers (MSW). One study in suburban Mumbai reported an HIV prevalence of 33 percent among the study group (17 percent in men and 41 percent in transgenders).20 All of the individuals in the study had reported anal sex and 13 percent had never used a condom, highlighting the need for increased attention and prevention efforts among this group.
India has one of the largest road networks in the world, involving millions of drivers and helpers. Truck drivers spend long periods of time away from home, and it is common practice for them to have relations with sex workers while on the road. A 2008 study showed that nearly a third of the long-distance truckers had paid for sex in the past twelve months.21
"There is no entertainment. It is day-in-day-out driving... When they stop, they drink, dine and have sex with women. Then they transfer HIV from urban to rural settings". - 22
Sometimes, relations with sex workers occur at roadside ‘dhabas’, which act as both brothels and hotels for truck drivers. In other cases, drivers stop to pick up women by the side of the road, and transport them to another area after they have had sex with them. Both truck drivers and sex workers move from area to area, often unaware that they are infected with HIV.
There have been a number of major HIV/STI prevention projects aimed at truckers, many of which have aimed to promote condom use. Some of these projects include not just truckers, but also other stakeholders such as gas station owners and employees. A specific example from Mumbai is the AIDS Workplace Awareness campaign, which is mandatory and which targets the drivers at the regional transport authority, where the drivers get their licenses renewed annually.23
Other campaigns have targeted the wives and partners of truck drivers, who often become infected when their partner returns home after a long absence. Yet as the testimony of one woman in Vijayavada demonstrates, these campaigns do not always manage to reach those at risk:
“My husband is a truck driver and I got HIV through him. I had never heard of HIV or condoms before that and because I can't read, I couldn't understand any of the posters or banners.”24
There are signs that some efforts to prevent HIV among truck drivers have been successful. For example, a recent survey of truck drivers in Tamil Nadu - carried out after an HIV prevention program - found that the proportion of drivers who reported engaging in commercial sex declined from 14% in 1996 to 2% in 2003. Of those who did report having commercial sex, the proportion that had not used a condom the last time they did so fell from 45% to 9%.25
Injecting drug users
Nationally, HIV prevalence among injecting drug users (IDUs) appears to have declined slightly in recent years to around 7 percent in 2006.26 However, transmission through injecting drug use is still a major driving factor in the spread of HIV in India, particularly in north-eastern areas, such as Manipur and Nagaland. One study found HIV prevalence ranged from 23 percent to 32 percent in different areas of Manipur.27 In 2006 new sites of high HIV prevalence among IDUs were identified in Punjab, Tamil Nadu, West Bengal, Kerala and Maharastra.28
“Harm reduction is the urgent, practicable and feasible HIV prevention method among Injecting Drug Users and their sex partners.”
The alarming levels of infection occurring through needle-sharing have implications that extend beyond networks of drug users. Some of those who inject drugs are also sex workers or truck drivers, and many are sexually active, which can result in infection being passed on to their partners. Experts have argued that there needs to be more information aimed at both injecting drug users and their sexual partners.29
The Indian government’s approach to drug use is based around law-enforcement and prosecution, with very little done in terms of treating drug users or helping them to stop using drugs. Harm reduction – a method of HIV prevention that has been successful in other countries, which acknowledges that drug use occurs and seeks ways to reduce HIV transmission in this context – has not been adopted in the government’s drug policies.30 Some states, however, such as Manipur, have adopted their own harm reduction policies and consider that:
“Harm reduction is the urgent, practicable and feasible HIV prevention method among Injecting Drug Users and their sex partners.”31
In the majority of Indian states, though, tough regulations on drug users make it hard to reach this group with HIV messages, and to survey how they are being affected by the epidemic.
Sex between men is highly stigmatised in India and is not openly talked about, making it easy for people to underestimate how commonly it occurs. Studies have shown that sexual activity between men is relatively common in both urban and rural areas of India.32
In India, many men who have sex with men (MSM) do not consider themselves homosexual, and a large number have female partners. A large study in Andhra Pradesh found that 42% of MSM in the sample were married, that 50% had had sexual relations with a woman within the past three months and that just under half had not used a condom.33 As such, unprotected sex between men can also present a risk to any women that they may subsequently have sex with.
The stigma surrounding MSM makes it hard for both the government and NGOs to reach them with information about HIV. Outreach workers and peer educators working with MSM have frequently been harassed by police, and in some cases arrested. In 2001, four members of the Naz Foundation Trust (an Indian NGO that works with MSM and other groups affected by HIV) were jailed for 47 days after police raided their offices:
“I was arrested for promoting homosexuality. The leaflets we use for our outreach work were dubbed obscene. The police claimed that the replica of a penis used to demonstrate the proper use of condoms was actually a sex toy!”Arif Jafar, Naz Foundation 34
Since conditions are so restrictive, there is little information available to MSM in India. Because so many MSM also have heterosexual relationships, there is a high chance that rising levels of infection among MSM in India will aggravate the epidemic among the general population.35 It is hoped that since the law that criminalises homosexuality was abolished in July 2009, MSM will be easier to reach with HIV prevention, treatment and care services.36
Studies from across the world have linked migration to multiple sexual partners and increased HIV transmission.37 It has been said that migrants and other mobile individuals are bridge populations for HIV transmission from urban to rural areas and between high-risk and low-risk groups. A large number of people move around India for work; it is estimated that 258 million adults in India are migrants, the majority are men migrating for employment.38
Long working hours, isolation from their family and movement between areas may increase the likelihood that an individual will become involved in casual sexual relationships, which in turn may increase the risk of HIV transmission. In many cases, migration does not change an individual’s sexual behaviour, but leads them to take their established sexual behaviour to areas where there is a higher prevalence of HIV. Therefore not all migrants are at equal risk of HIV.39
“Being mobile in and of itself is not a risk factor for HIV infection. It is the situations encountered and the behaviours possibly engaged in during mobility or migration that increase vulnerability and risk regarding HIV/AIDS.” - UNAIDS 40
A study in 2008 identified a notable proportion of contractual workers who had used alcohol and engaged in paid and unpaid sex with women.41 The study also showed a significant number of the men had not used condoms, highlighting the need for increased prevention efforts among this group. NACO recommend targeted HIV prevention programmes primarily for men who are both migrants and part of high risk sex networks, due to the extremely large size of the migrant population in India.42
There is evidence that some prevention strategies have been successful in reducing HIV prevalence among certain groups in India. However despite these successes, there are still around 2.4 million people infected with HIV and many parts of India's epidemic remain unnoticed. The risk of HIV infection among male sex workers, and the role of MSM in the epidemic, are just two largely ignored areas. As well as addressing high prevalence groups, more attention is needed for people perceived to be at low risk, such as married women, as HIV spreads amongst the general population.
"HIV prevention and intervention strategies need to focus on married, monogamous Indian women whose self-perception of HIV risk may be low, but whose risk is inextricably linked to the behaviour of their husbands". - 43
The HIV epidemic in India has been described as 'highly heterogeneous' – in that it affects very diverse sectors of society. More effort is therefore needed to identify these people, prevent new infections, and treat those already living with HIV/AIDS in India.
AVERT has more information about prevention, stigma, treatment and the future of the HIV/AIDS epidemic in India.
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 2.3 million people are currently living with HIV.1
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,2 India had no reported cases of HIV or AIDS.3 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.”4
Later in the year, India’s first cases of HIV were diagnosed among sex workers in Chennai, Tamil Nadu.5 It was noted that contact with foreign visitors had played a role in initial infections among sex workers, and as HIV screening centres 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.6 7
In 1987 a National AIDS Control Programme was launched to co-ordinate national responses. Its activities covered surveillance, blood screening, and health education.8 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.9 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).10
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 Organisation), to oversee the formulation of policies, prevention work and control programmes relating to HIV and AIDS.11 In the same year, the government launched a Strategic Plan for HIV prevention. This plan established the administrative and technical basis for programme management and also set up State AIDS bodies 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.
By this stage, cases of HIV infection had been reported in every state of the country.12 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.13 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 recognise as being at risk. AIDS is coming out of the closet.”14
In 2001, the government adopted the National AIDS Prevention and Control Policy. During that year, Prime Minister Atal Bihari Vajpayee addressed 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.15
HIV had now spread extensively throughout the country. In 1990 there had been tens of thousands of people living with HIV in India; by 2000 this had risen to millions. 16
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.17 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.18
In 2008 the figure was confirmed to be 2.5 million,19 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.20 In addition, NACO released figures in 2008 suggesting that the number of people living with HIV has declined.21
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, Delhi22
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”23
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
he 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.24
The following states have recorded the highest levels of HIV prevalence at antenatal and sexually transmitted disease (STD) clinics over recent years.
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 is still highest out of all states.25 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%).26
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.27 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.28
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 2007.29 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.30 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.31
Maharashtra is a very large state of three hundred thousand square kilometres, 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 2007.32 At 18%, the state has the highest reported rates of HIV prevalence among female sex workers.33 Similarly high rates were found among injecting drug users (24%) and men who have sex with men (12%).34
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%.35 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 behaviour had decreased.36
In 2007 HIV prevalence among antenatal clinic attendees was 0.25%.37 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.38
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.39 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%.40
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 2007.41 Estimated adult HIV prevalence is the highest out of all states, at 1.57%.42
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.43 In recent years the average prevalence among this group has been much lower, at around 3-7%.44 HIV prevalence at antenatal clinics was 0.75% in 2007.45
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 2007.46
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 occur through heterosexual sex, and most of those who become infected would not fall into the category of ‘high-risk groups’ - although members of such groups, including sex workers, men who have sex with men, truck drivers and migrant workers, do face a disproportionately higher risk of infection. See our page on affected groups in India for more information.
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 Programme (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.47
The third stage of the National AIDS Control Programme (NACP-III), was launched in July 2007 and runs until 2012.48 The programme has a budget of around $2.6 billion, two thirds of which is for prevention and one sixth for treatment.49 Aside from the government, this money will come from non-governmental organisations, companies, and international agencies, such as the World Bank and the Bill and Melinda Gates Foundation. 50
The government has announced that this campaign will place a strong focus on condom promotion. It has already 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!’, 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.51
In one unique scheme, health activists in West Bengal are attempting to promote condom use through kite flying, which is popular before the state’s biggest festival, Durga Puja:
"The colourful 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." - 52
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 organisations, 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 organisations 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.53 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.54
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 counselling and testing centres (ICTCs) in India. By the end of 2008 there were 4817 ICTCs in India,55 compared to just 62 in 1997.56 In 2007 these centres tested 5.9 million people for HIV, an increase from 0.14 million in 2001.57
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, the state government recently planned 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.58 Neither of these plans have 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.59 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 stigmatise HIV positive people and discriminate against them, including testing them without consent.
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 severely limited in India; an estimated 235,000 people were receiving ARVs by the end of 2008.60 Some of these people manage to access the drugs through private health facilities, which dominate India’s healthcare sector, but the vast majority of people cannot afford to buy treatment privately.
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 2007 there were 137 reported sites providing antiretroviral therapy.61
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 centres in Mumbai and Chennai. At the beginning of 2009 second-line therapy was available in a total of eight states.62 However, the large scale of India’s epidemic, the diversity of its spread, and the country’s lack of finances and resources all present barriers to India’s antitretroviral treatment programme.
Ironically, India is a major provider of cheap generic copies of ARVs to countries all over the world.
“It is a sad irony that India is one of the biggest producers of the drugs that have transformed the lives of people with AIDS in wealthy countries. But for millions of Indians, access to these medicines is a distant dream” Joanne Csete, Director of the HIV/AIDS programme at Human Rights Watch. 63
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.64
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,65 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 neighbourhood, they will kick you’. She feels that we should not talk about it.” Female student, Chennai66
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." - 67
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.68 People in marginalized groups - female sex workers, hijras (transgender) and gay men - are often stigmatised not only because of their HIV status, but also because they belong to socially excluded groups.69
To learn more about the way that prejudice is hindering the global fight against AIDS, see our Stigma and discrimination page.
The future of HIV and AIDS in 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.70 India's government responded by calling these figures completely inaccurate, and accused those who cited them of spreading panic.71 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. 72
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 73
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 minimise 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, Director of UNAIDS.74
I must clarify something, QTEL has banned this web site. Sorry for the large copy and paste.
Life is short. Break all the rules. Forgive quickly.
Kiss slowly, love truly and never regret the things that
made you laugh.
Graduated from Xavier Institute for Higher learning
u r welcome gulfguy77
Sad phase of life...
One shouldnot loose the correct path........to live safely till the life ends.
thanks for sharing roshu....
yes britexpat u r right.
sir dolly......it's an old story, she died in 2007.
i read it somewhere like one month ago!!!
I'm Jack's complete lack of surprise
Aids is a terrible desease and should not/must not be taken lightly. many of us hide our heads in the sand and pretend that it does not exist. We need to accept that it prevelaint in society and takes steps to address its issues including prevention, treatment and help to the victims.