|
|
|
|
| Home » Guest Column » Renuka Motihar |
| |
 |
|
GUEST COLUMN |
|
| |
HIV/AIDS response
in India: What more needs to be done?
Renuka
Motihar |
| |
 |
Approximately 5 million people
are living with HIV/AIDS in India today. Although India's
adult HIV-prevalence rate is low at about 0.8%, this converts
into staggering numbers due to India's enormous population.
Migration has added another dimension to the HIV epidemic
in India. Significant migration exists between states
in India and between neighbouring countries. Industrialised
states with relatively high HIV rates, such as Maharashtra,
Gujarat and Andhra Pradesh, attract male and female labour
from all over the country, particularly from poorer states,
which may soon lead to significantly higher HIV rates
in these states as well. Despite the rapid spread of HIV,
the national response has been inadequate. Denial, the
scale of the problem, and the unfavourable political and
cultural context have impeded progress. HIV/AIDS has led
to the threatening questioning of moral and cultural mores.
It is breaking taboos about discussing sex and raising
questions about human rights and health care. |
|
| |
| India's strong tradition of social
and political activism has yielded some innovative grassroots
programmes, such as the Sonagachi project in Kolkata and the
Sangram initiative with sex workers in Sangli, Maharashtra.
In Sonagachi, sex workers formed a union and advocated for the
decriminalisation of sex work, human rights and AIDS education.
Empowered sex workers refuse unprotected sex with clients. However,
India's size and diversity means that such efforts remain isolated
islands of excellence. A major drawback has been that that the
civil society experience has not been systematically analysed,
evaluated and documented. Hence, this experience has been largely
under-utilised and difficult to scale up. In the late 1990s,
PLWHA groups and networks emerged at national and state levels,
bringing a human face to HIV/AIDS. As an advocacy and activism
force they are trying to break the stigma and discrimination
within Indian society. |
| |
| A number of key lessons have been learned and
priorities have emerged from the experience of the last 15 years.
Crucial issues are the need for stronger political commitment
and for open discussion of sexuality issues. Another priority
is the need to develop a continuum of care model that integrates
prevention and care programmes. Infections occur in new areas
and new groups, highlighting the need for continued prevention
efforts, with special attention to the issues of low-risk populations,
bridge populations and the third HIV wave among newborns. The
growing number of HIV-infected women – many married or
in single-partner relationships – highlights the importance
of specific programmes to empower women and challenging age-old
traditions regarding women's position in Indian society. Similarly,
more intensive and open AIDS education for in- and out-of-school
youth is crucial. Given India's low school enrolment and high
school-dropout rates, out-of-school youth are more vulnerable
and need AIDS intervention tailored to their situation and needs. |
| |
| At the same time, the need for care and support
has increased enormously. Priorities in this field include quality
and accessibility of anti-retroviral therapy; greater involvement
of PLWHA; and development models of best practices. An important
priority is the reduction of AIDS-related stigma and discrimination,
especially within the health, educational and legal systems:
there have been cases of children being ostracised and denied
admission to schools because of their HIV status; some doctors
and hospitals turn away patients with AIDS related diseases;
and the police harass and intimidate sex workers. |
| |
| While successful initiatives have been implemented, a lack
of analysis, evaluation and documentation has meant that potential
‘best practices' are insufficiently known. In order to
facilitate more evidence-based programming, innovative research
of programmes with increased coverage and scaling up is badly
needed. India needs to strengthen its efforts urgently: as the
remaining small window of opportunity is threatening to close
down rapidly. |
| |
| |
| The piece has been adapted from article “Strengthening
India’s response to HIV/AIDS” by Renuka Motihar
and Vaishali Sharma Mahendra published in Sexual Health Exchange,
KIT, Netherlands, 2003 |
| |
| |
| About
the Author |
| |
|
| |
| |
| Previous
Guest Columns |
| |
| |
| |
| |
| |
|
|
|
