Illustration: P. K. Job, DC
HIV has come knocking on the front doors of homes in Tamil Nadu.
The virus disease is now spreading to housewives and professional women more than ever before.
Research by National AIDS Control Organisation shows that intervention has succeeded in lowering the incidence of HIV infection among commercial sex workers from 10.3 per cent to 4.9 per cent from 2003 to 2008, but the ratio of all men and women infected with the virus has remained almost constant at 60:40.
Doctors have concluded that the new wave of infections has afflicted mostly women who are not commercial sex workers.
Another study by YRG CARE involving subjects from Chennai shows that over 22 per cent of the identified HIV+ cases in the city are housewives. Even though the YRG study did not include commercial sex workers, doctors say the statistics are a cause for concern.
When contacted, Suniti Solomon, founder-director of the centre, said, “We should have been alarmed several years ago.”
A national report submitted to the United Nations claims that “the HIV epidemic in India is entering a phase where new infections are increasingly occurring within intimate partner sexual relationships”.
Women account for about 40 per cent of the infected population, half of whom are housewives (about 22 per cent of the total) and the other half are students and working women. Most of the infections acquired by these women are through their husbands or sex partners.
Furthermore, a recent study shows that if a man has HIV, his wife may or may not have the disease, but if the woman has HIV, 80 per cent of the time, her partner will as well.
“Women who know that their husbands have HIV continue to have sexual intercourse with him; and fail to protect themselves as they hope to have a child. They say that they can deal with the stigma of being HIV+, but not with the humiliation of being considered ‘barren’,” says Dr Suniti.
Rashmi (name changed), 26, an IT professional, did not even know that she was infected until two years after her wedding when she went in for pre-natal testing. “I didn’t know what to do, or how this happened. It was horrible.” After a great deal of soul searching, she decided not to get pregnant and explore other alternatives. She is not alone. Dr Solomon, who documented the first case of HIV in India in 1986, estimated that over 70 per cent of the people living with HIV are unaware that they have been infected.
Unfortunately for residents of Chennai, Tamil Nadu is one of the states with the highest rates of infection in India.
The transmission of AIDS in the country is patchy: 60 per cent of the people living with HIV are concentrated in six states. Even the low transmission states, one can no longer assume that only the marginalised communities and high-risk groups should worry.
The Indian woman now needs to be aware of the issue and take care of herself.
Dossier of the affected
*The spouses of HIV+ migrant workers are less likely to be HIV positive themselves.
*80% of all men married to HIV+ women will be HIV+ themselves. Only 50% of the women married to HIV+ men will be HIV+ themselves. This number is almost 10% higher for women married to IDU HIV+ men.
*A couple both of whom are HIV+ are 60:40 likely to be urban residents rather than rural folk.
*In less than four months of the primary partner starting treatment, one in three initially negative spouses will acquire the disease.
What is the Government doing?
To alleviate the staggeringly high number of people living with HIV, the government has been pushing for voluntary testing and counseling, establishing over 6,000 ICT Centres, including in rural areas.
While HIV prevalence has decreased in high-risk populations due to focused and sustained intervention by both government and NGOs, the report of so many HIV cases among the general population cannot be ignored.
Drugs will get expensive
The strategy for managing AIDS in India is to provide free drugs at ICTC centres, lower risky behavior though awareness campaigns such as those to encourage the use of condoms during sex and finally, to encourage people to come in for voluntary testing and counseling.
The Government of India provides free drugs to registered people living with HIV at about 300 Anti-Retroviral Treatment Centers. Dr Solomon said that some of her patients react casually to the news, “I’ll just pop the pills and go on with my life.” But that may not be so simple in the future.
While the first line drugs are available in 300 centers, second line drugs (more expensive, newer, to be used when the first fail) are available only at 10 centres. Following the Free Trade Agreement that India signed, however, any new drugs for HIV could be very expensive — either for the common man or to the government, if it chooses to subsidize it. “There would be a huge impact on HIV patients for new drugs, which would be subject to that agreement. It will get very expensive,” said Dr Solomon.