The World vs. AIDS, 2004

India's Growing AIDS Problem

Indian children march to raise awareness of AIDS
Students in New Delhi participate in a march to raise awareness of AIDS on the eve of World AIDS Day, Nov. 30, 2003 (Photo: Pankaj Nangia/The Times of India-AFP).

Have you ever met someone who is HIV-positive? Going by the government’s statistics, you must have. There are 4.58 million people living with HIV/AIDS in India, says the National AIDS Control Organization (NACO). That’s 0.8 percent of the country’s population, roughly one infected person in a group of 100.

Think about it. You probably had dinner with an HIV-positive person at the last wedding you attended, or rubbed shoulders with more than one while shopping at the India International Trade Fair. Your child may be at school with HIV-positive children without your being aware of it. It’s likely that no one in the school knows either.

For if their HIV-positive status were known, chances are they would be thrown out of school, like 5-year-old Benjy and 8-year-old Benson in Thiruvananthapuram [capital of Kerala]. If they are “lucky,” like the Kerala siblings, their plight may make headlines. Union Health Minister Sushma Swaraj may intervene and hug them, and get color posters made of the now familiar embrace for national and international AIDS campaigns. The school would be forced to take them back, but once the photo ops are over, they would become untouchable again and be asked to sit away from other students. No other child would come near them. That’s what’s happening to Benjy and Benson. Their grandfather—their parents and elder brother died of AIDS—is happy that they are at least getting an education. “I hope they get to study and play with other children in the future,” he said on his Delhi visit for World AIDS Day this year.

When it comes to HIV, discrimination is still the norm. Many prefer not to confirm their positive status and be ostracized. While the National AIDS Prevention and Control Policy ensures protection of human rights, it does not have teeth. To give it legal sanction, Swaraj announced recently that she would table the AIDS legislation protecting the human rights of people living with HIV/AIDS in Parliament.

Courts have been proactive in ensuring rights, but the trickle-down effect has been just that—a trickle. In 1997, Mumbai’s High Court ruled that HIV-positive people cannot be denied jobs on account of their status. But while state institutions can be legally forced to hire a person, little enforcement exists in the private sector. Many firms insist on a health checkup before hiring prospective employees, and if a person tests HIV-positive, he or she is denied a job under another pretext.

People with AIDS are considered outsiders. This perception is incorrect. In India, the infection is increasing the fastest in monogamous married women. Now, out of every three HIV-positive people, one is a woman.

If you think NACO doesn’t know its numbers, think again. Actual AIDS cases and deaths apart, NACO’s projected numbers are based on data collected through sentinel surveillance at prenatal clinics, where pregnant women go for tests before delivery. In such states as Maharashtra, Tamil Nadu, Andhra Pradesh, Karnataka, Manipur, and Nagaland, more than 1 percent of women going for institutional deliveries are HIV-positive. These are not sex workers but married monogamous women, who barely speak to a man other than their husband.

In India, about 80 percent of HIV infection spreads through heterosexual sex, with 89 percent of those infected being in the 18-49 age group. Most people have the HIV-1 virus, which is globally the predominant strain. HIV-1 mutates easily and has many subtypes. While most subtypes are found in Africa, three strains—B, C, and E—predominate in the rest of the world. HIV-1 subtype C—which has a higher potential for heterosexual transmission—is the dominant strain in India.

The enormity of the problem has even turned the usually coy Swaraj into a champion of condoms; it has also prompted her to push for AIDS legislation and to offer free AIDS treatment to mothers, children younger than 15 years, and people living with HIV, beginning April 1, 2004.

HIV/AIDS can be contained—there are lessons from Brazil and neighboring Thailand—but to do that you have to talk about it outside conference centers reverberating with NGO rhetoric.