Opinion - Editorials

BATTLING HIV

RICHARD FEACHEM, EXECUTIVE director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, could not have been more blunt. HIV/AIDS is "a ticking time-bomb" for India, he said at a recent press conference in New Delhi. For good measure, he questioned the accuracy of the official estimate that there were 5.1 million HIV-infected men, women and children in India, pointing to the inadequacies of the country's sentinel surveillance network. Even the official statistics put India second only to South Africa in the number of infected people. But gross comparisons are often misleading. The favourable comparison with the much worse case of sub-Saharan Africa might actually have led to a general sense of complacency in India. There has been no shortage of warnings that such complacency is misplaced and dangerous. Two years ago, the United States National Intelligence Council estimated that there were five million to eight million HIV-infected persons in India and their numbers could swell to 20-25 million by 2010. Last year, a report from the Global HIV Prevention Working Group warned that "China and India stand on the brink of widespread epidemics, as HIV spreads from groups at high risk to the broader population." Writing in BMJ (the British Medical Journal), two experts from the University of California, Berkeley, observed that "India shares some of the same risk factors as Africa, including a similar pattern of health expenditure, an uneven health infrastructure, and prevalent high risk sexual behaviour."

Action is needed on several fronts if India wants to avoid going the way of southern Africa. Considering that there are already several million HIV-infected people in this country and that this number is bound to grow, the fight against stigmatising and ostracising those who are HIV-positive assumes considerable urgency. If people fear discrimination, they are likely to shy away from blood tests that are the only way to discover their HIV status. They will be reluctant to seek help and adopt preventive measures. All this increases the chances of the infection being passed on to others. A report issued by Human Rights Watch a few months ago chronicled horrific examples of discrimination and abuse that children in India who are HIV-positive (or suspected to be so) have had to endure. Even in highly literate and socially progressive Kerala, parents have objected to HIV-infected children being admitted to school. In one recent case, two infected children were admitted on condition they would be seated in a separate room.

Self-evidently, prevention is the key to limiting the spread of HIV/AIDS. Women in India are particularly vulnerable as they can be subjected to sexual violence within and outside marriage; have limited access to reproductive health services; and are often ignorant about HIV and how it spreads. Sexual fidelity is no guarantee that they will not be infected with HIV and age-old attitudes make it difficult for them to insist that their husbands use condoms. These problems must be addressed boldly but sensitively for prevention to become a winning strategy. As HIV is spreading in India primarily through sexual contact, a great deal more must be done to raise awareness on issues such as promiscuity, visits to sex workers, and men having sex with men. The big challenge is to promote safer sex practices. As Dr. Feachem remarked, fighting HIV/AIDS is not a task that the Government will be able to tackle all by itself. It is a fight to which everyone — corporate bodies, NGOs, all manner of community organisations, and ordinary citizens — can and must contribute.

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