The New England Journal of Medicine recently published a short “perspective” piece on the state of HIV/AIDS in India. This is the first article in what appears to be a series, the next one is on the challenges involved in containing HIV in India. Here are a few points from the piece:
We don’t know how many people have HIV in India
The best estimate right now is 5.7 million HIV infected Indians, that’s one in every eight cases world wide (India has one in every six people in the world). However, there is a great deal of uncertainty around this number:
The epidemiologic data for India (estimates of the number of infected persons range from 3.4 million to 9.4 million) are far less precise than for South Africa … In 2005, no data were available for many of India’s more than 600 districts. [Link]
See the image to the right? The data come from the National AIDS Control Organization. The northern states are all blank because there isn’t enough data. That’s really distressing.
Estimates indicate that rates are not (yet?) high in the general population:
The estimated HIV prevalence among people 15 to 49 years old in India is 0.5 to 1.5%, whereas in South Africa it is 16.8 to 20.7%. [Link]
But higher in high risk subgroups:
Female and male sex workers, men who have sex with men, and injection-drug users have the highest rates of infection — surveys typically find a prevalence of 10 to 20%…. [Link]
Prevention faces many hurdles, especially amongst women:
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p>Across India as a whole, only 35% of women know that consistent condom use can reduce the risk of infection. However, since 37% of women who have been married at one point have experienced sexual abuse, not all women have much leverage to negotiate.
Prevention of HIV transmission is hampered by gaps in knowledge and by cultural, legal, and medical factors. For example, the most common means of contraception in India, particularly in the south, has historically been sterilization of women, typically done before they turn 30 . In Andhra Pradesh, female sterilization is used for family planning by 62.9% of married women and condoms by only 0.5%. Advocating the use of condoms has been viewed as promoting promiscuity. [Link]
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As one expert said:
… “marriage is a must” in India, but protecting married women from infection “is a major problem. It is not socially appropriate for a wife to discuss using condoms with her husband. She is not able to negotiate safe sex. [Link]
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p>Furthermore, most of those infected with HIV are unaware:
… only an estimated 10 to 20% of those infected know that they are infected, which impedes treatment and prevention efforts. [Link]
Which makes it harder to stop the spread of the disease.
Here are just a few of the many posts we’ve written on the past on this subject: India in Focus on World AIDS Day, World AIDS Day on Indian Standard Time, Fight AIDS in your Computer’s Spare Time!, AIDS ’06, India Leads in … AIDS cases?, Treating AIDS patients like animals, Bachchan joins Mandelas anti-AIDS campaign, 25, Baby Blue Turbans for Sexual Frankness!
Also see: Wifebeating worldwide, Sex by the numbers
given the cricket mania in the subcontinent right now, it’s good to see that the ICC is using this world cup and its star cricket players to spread the message of combating AIDS and the stigma attached to it in the subcontinent.
During 2002 National games, AP Govt has made condoms available for free at almost every mile post within Vizag and Hyderabad (besides other cities). There were statistics always stating that North coastal Andhra to be having most HIV cases and that map is sure alarming.
The sex-trafficing is nothing compared to what it is in other parts of India, but why is the HIV is so much more prevalent in this area?
Prasad, I don’t know, but this table shows that only 0.5% of couples in Andhra use condoms as opposed to 23% in Delhi.
The article also says that there is a lot of sex work on the coast.
I’m sorry to hijack, but only for a second: That map really matches the sepia color scheme in a major way. Done.
Prasad, The dark areas seems to correspond to East godavari & Guntur districts. Peddapuram and Chilakaluripeta are famous long before first case of AIDS case was ever discovered. Knowledge and use of condoms is still far from 100% among educated youth. The dark areas will remain as long as condom usage among commercial sex workers is low.
We launched a hostile takeover of the NEJM 2 quarters ago, but we’re trying to keep it on the down lo.
🙂
Yes, you are correct about their infamy. However, I didnt realize that they are still as infamous even today. About the usage of condoms, I am aware of youngsters who are bullied by their elders (who think in lines of Catholics) into not using any protection. I once overheard a mom telling her daughter not to use protection, because it might affect the fertility of her eggs. Needless to say (and to much delight of elders), this chica was pregnant within 3 months.
Tells me that, emotional blackmail and elderly bullying tactics are much more potent than education after all.
4,6,7: Snort.
I think one way of promoting condoms is highlighting it as a good health tool even for married, healthy, monogamous couples. It helps protect both parties from UTIs and fungal infections that are STDs but also not just STDs–i.e. a faithful person get get a UTI non-sexually and then pass it on to their partner. I read an article once in which a porn producer said that as a matter of principle, he never allowed a male member on screen without a very prominent and visible condom—none of this translucent, “barely-there” business. If condoms were marketed as a necessary and fashionable accesory for married couples, it would help ease the stigma for everyone else.
I have close friends from those areas and they are as infamous as ever. What I found interesting was that non-english-medium swaathi reading non-hep crowd were more aware and open to contraception & condoms than some of us city folks. Many people still think promoting condoms as encouraging promiscuity.
I had been hoping somebody would comment on what I thought was the most shocking part of this article – the 37% spousal abuse rate. It’s in their tables, and I can’t see where it comes from. I might just need to write another post on just those numbers alone.
In this context, abuse or not, it is just culturally icky to ask your partner to use condom during marriage. It is not like the rest of 63% non-abusers are using condoms. What i find annoying is that all reports about AIDS in India is based on data collected in these four states. Till we have data from UP & Bihar, all those reports with, it is not spreading/we have it under control/our measures are working/our culture has protected us/ line need to be taken with a huge grain of salt. These states have huge migrant labor population who sometimes stay away for home for years. And they don’t practise safe sex measures when they come back home.
I count 8 states, but you’re right, it’s not useful unless you’re talking about the more populous northern states.
How true does this ring with the experiences of people participating on this blog? Any insight into your parents’, grandparents’, aunts’, uncles’s marriages? Is this statement really true?
I often hear how Indian woman are the “heads” of their households in India. If this is the case, such an attitude would be very incongruant.
flesh trade and extra marital affairs are the part of the culture of Chilakaluripeta and Pedda puram. In those areas there is no difference between a family women and prostitute. During the festivals they organise naked dance shows which they call “Prabha”s. When my friends went there to conduct some surveys, they found that the men encourage their women for fresh trade. When I went to another place in those areas,the moment we take an auto rikshaw, they start requesting us to visit brothel houses. No wonder those areas are being top in AIDS list.