HIV-AIDS (Human Immunodeficiency Virus) in India
History of AIDS in India
According to the World Health Organization (WHO), nearly 2.39 million people within India live with HIV/AIDS and, as a result, India is considered to be a hot bed for the spread of the disease. Based on current records by the government, the regions with the highest rates of HIV infection are Andhra Pradesh (500,000 reported cases), Karnataka (250,000 reported cases), Maharashtra (420,000 reported cases), and Tamil Nadu (150,000 reported cases) (Iqbal et al. 2012, pp. 397-402). In total, these specific regions account for more than 55% of HIV infections within India with the regions of Uttar Pradesh, Gujarat, West Bengal and Bihar having 100,000 cases each and constitute 22% of the HIV infections within the country (Iqbal et al. 2012, pp. 397-402).
It is quite interesting to note that while the world took notice of AIDS in 1986 with well over 20,000 cases being reported in various regions around the world, India had no reported cases whatsoever during this particular period of time. It was only in 1987 when extensive testing procedures were implemented that cases of HIV began to appear of which a majority was attributed to drug users (i.e. the sharing of needles lead to infection). From there, the disease spread mostly through heterosexual intercourse result in 5.6 million people being infected with HIV by 2006. However, through the efforts of the Indian government, the total number of infected individuals has dropped by 50% within the past decade with the WHO (World Health Organization) stating that only 0.3% (2.31 million) people are infected with HIV in India with the number of new reported cased dropping per year. It has reached a point that on average only 195,000 thousand people per year within the country die of HIV/AIDS related complications with the number expected to drop by 25 to 50% within the next two decades as a result of efforts by local government units to stamp out the disease.
By the numbers alone, it can be seen that India has a significant amount of HIV cases which is exacerbated by its conservative society. Indian society both stigmatizes those with HIV resulting in a lower likelihood of someone with HIV actually reporting it as well as has an innately low level of sexual education due to the connotation that sex should only be for those who are married which results in the prevalence of unprotected sex (Venkataramana & Sarada 2001, pp. 1040-1061).
HIV/AIDS in India
Through the examination of Mitra & Sarkar (2011), which examined the current efforts of the Indian government in tackling the issue of AIDS through education, it was noted that India has taken substantial strides in reducing the rate of infection through local capacity building and educational programs for at risk population sets. Such programs are often concentrated in Maharashtra, Karnataka, West Bengal, Gujarat, Bihar and Uttar Pradesh where the greatest levels of infection within the country have been noted (77%). However, despite the general success of the program which is attributed to reducing the prevalence of HIV by 3.09% within the past few years, the fact remains that given India’s current problem with overpopulation with up to 1,210,193,422 people living within the country, the government has little in the way of sufficient resources to be able to actively implement a sufficiently broad enough program that the most at risk sector of the population (i.e. people aged 15 to 49 years of age) can be effectively targeted.
Despite India being one of the most active countries in the world in terms of implementing education programs to tackle the issue of HIV, Bharat et al. (2013) stated that the sheer amount of people within the country along with conservative local customs, a lack of active transmission of safe sex practices from adults to children as well as the general stigma associated with women having sex prior to marriage have reduced the overall effectiveness of such programs resulting in a lower rate of decline than would have been expected despite the $2.5 billion that was allocated by the country in order to resolve the threat of AIDS.
Through the analysis conducted by Ram et al. (2012), it was noted that condom use within India was quite low with less than 10% of the population being active users. Ram et al. (2012) stated in their study that condoms and the use of other methods of birth control within the country are not as prevalent given the negative connotation attached to sexually active women. It is usually the case that Indian culture places a high degree of importance on the concept of “virginal brides” and, as a result, there is little in the way of sexual education for women from their parents or peers.
While there are educational programs within India, studies such as those by Bishnu et al. (2013) explain that they occur far too late in life to be truly effective later on. The Bishnu et al. (2013) study stated that, within India, the occurrence of HIV in certain sectors of the population can occur in people as early as 15 years old. However, education involving methods of safe sex in the current system of education occurs later on when a person reaches 18 and above. This period of time between when an individual becomes sexually active and when they are taught proper methods of safe sex results in a greater possibility that they would catch HIV prior to when they should be taught the means by which they can avoid it (Rodrigues et al. 2013, pp. 1-8).
Prevalence among Children
It is quite shocking to see that the children below the age of 15 make up 3.5% of all HIV infections within India. This accounts for nearly 10 to 20 thousand cases of HIV and shows the depth of the present day problem. Though the number of those infected has been going down in recent years as a result of greater levels of detection, the sheer number of infected children still dwarfs those of many developed countries (Bachani & Sogarwal 2010, pp. 469-472).
Through the analysis of Ahmed & Bhattacharya (2013), it was noted that transmission of HIV when it came to children was primarily caused during birth or breastfeeding. Despite the staggering numbers of infected children, progress has been made in curbing future infections through early onset identification at hospitals as well as through more educational processes which focus on educating people early on regarding the warning signs of HIV infection and what processes can be done in order for it to be reported (Arora et al. 2012, pp. 1-11).
Prevalence among Women
Surprisingly, despite the considerable level of pre-marital sexual conservatism, women actually constitute 39% of the current population in India that live with HIV. According to the World Health Organization, this means that nearly 950,000 women within India are infected with HIV/AIDS and, as such, have a high change of passing the disease to their children. Most women who have HIV in India are usually 16 to 29 years old and normally catch it from sexual interaction with their spouse. An examination conducted by Mukherjee (2010) to determine why such a large population of female HIV carriers exist despite the relatively conservative society within the country revealed that infection often came about through birth or from their husbands who themselves had HIV yet did not know about it. While some cases were a direct result of unprotected pre-marital sex, a majority of the cases came about as a direct result of the local culture which places a considerable level of stigma on individuals with HIV. Kohli et al. (2011) explained that within India, there is a widespread stigma against men with HIV infections wherein they are connoted as being unclean, were homosexuals (i.e. the belief that HIV comes from having sex with another man) or that they were either drug users or utilized the services of sex workers. The end result is that woman wind up getting HIV from their husbands and transmit it to their child. Should these children get married and pass on the disease, Thappa et al. (2007) stated this can result in an ever escalating level of transmission which is one of the main reasons behind the high rates of HIV cases that are reported per year.
Prevalence among Teenagers
Data from the WHO states that nearly 150,000 to 250,000 teenagers within India are infected with HIV/AIDS with the age ranging being situated between 15 to 18 years of age. Through the work of Saggurti et al. (2012), it was seen that HIV infection rates are actually the most prevalent for individuals ranging between 15 to 49 years of age. This means that teenagers as young as 15 years old within India have a high susceptibility to the disease. Saggurti et al. (2012) goes on to explain that one of the reasons behind this level of susceptibility is connected to the lack of condom usage among teenagers within the country. Through the interviews conducted by the Saggurti et al. (2012) study, it was noted that the idea of condom usage among the country’s teens was different depending on that specific individual’s financial background. Those from India’s middle and upper class were more likely to utilize condoms during sex since it was noted that they had more knowledge regarding how unprotected sex could lead to unwanted pregnancies or the transmission of STDs. As a result, the Saggurti et al. (2012) study revealed that teenagers within the upper to middle class population sect had relatively fewer cases of HIV infection and had fewer unwanted pregnancies. On the other end of the spectrum, those who belonged to the lower class of India’s society rarely utilized condoms. It was revealed by Saggurti et al. (2012) that those belonging to low income families practiced unprotected sex since they lacked sufficient knowledge regarding the inadvertent consequences that may result from their actions. They had insufficient levels of knowledge regarding STDs and HIV and generally though that such conditions were relegated to the “unclean” and that they did not have the possibility of possessing them. As a result, they engaged in unrestricted sexual activities which increased the potential for the transmission of HIV. Another problem that should be taken into consideration is that teenagers are even less likely to go in for HIV testing as compared to their adult counterparts which means that teenagers who have HIV are more likely to continue being sexually active which results in a greater likelihood of the disease spreading. Vaidya & Jianhong (2011) explained that this is one of the reasons why the prevalence of HIV among India’s population starts so young since the lack of awareness coupled with low levels of condom usage among teens from low income families combine to actually exacerbate the spread of HIV.
Prevalence among Sex Workers
HIV and its prevalence among sex works is one of the leading causes for the spread of HIV within India. Based on data from the WHO, nearly 20 to 30,000 sex workers within India (foreign and local alike) have HIV/AIDS which they contracted from their clients. These Individuals are usually 20 to 30 years old and have been in the sex trade for up to 5 years or more. This means that such individuals could have the potential to infect hundreds if not thousands of people throughout their careers.
What must be understood is that in the case of India’s underground sex trade, condoms are rarely utilized. This is quite different as compared to the case of the sex trade within the U.S., U.K. and Australia wherein condom usage is almost compulsory given the fears of unwanted births or sexually transmitted diseases. In the case of India, it was revealed by the Eicher et al. (2000) study that sex workers lacked sufficient knowledge regarding the potential dangers surrounding HIV and, as such, regularly practiced unprotected sex with their clients. This factor, when combined with the regular migration and mobility of India’s sex workers from city to city results in the spread of HIV infections (Raj et al. 2001, pp. 1374-1381). It was due to revelations such as this that the government has focused on both cracking down on illegal sex dens and sex workers as well as attempting to educate young women who they believe to be part of the sex trade regarding the risks of HIV infection and the necessity of utilizing condoms when having sex.
Prevalence among Men
According to the WHO, 1.3 million men within India are infected with HIV/AIDS as a direct result of sexual intercourse, drug usage or getting infected at birth. Overall, nearly 61% of all those with HIV infections are male who are between 18 to 49 years of age (Chakravarti 2011, pp. 389-400).
Evaluation of the Quality of Data available on AIDS in India
When looking at all the data that has been presented so far, it can be seen that there has been extensive documentation involving the origin of AIDS/HIV in India, the various factors that facilitate its continued spread and how it has been steadily declining over the past decade. Ram et al. (2012) stated that there has long been a connection between the spread of sexually transmitted diseases and cultural stigmas surrounding sex education and the data shown within this study has backed up such a claim.
Overall, the quality of data available on AIDS in India is quite substantial given that the country has invested billions of dollars in combating the epidemic through education and social service programs.
Conclusion – What will happen in the future?
When taking into consideration the data that has been presented so far, it can be seen that India is still in for a long and hard fight against the spread of HIV within the country. While the number deaths can be expected to go down by at least 50% more within the coming decade to roughly 50,000 per year, the fact remains that the thousands that die every year is still unacceptable and, as such, the government of India still needs to do more to stem the tide of infection. One way in which this can be resolved would be to educate people early on in life such as when they turn 12 or 13 which would help to drastically reduce instances where condoms are not utilized. Unfortunately, one of the main hurdles is the local culture which connotes sex as an activity that is exclusive to married couples and does not take into consideration how it is an activity that is also prevalent among those who are not married. Not only that, there are also instances of male to male sex (i.e. homosexuality) which also acts as a means by which HIV is transmitted. In such cases, the absence of condom use was also due to a lack of education among members of the homosexual community. Studies such as those by Vicziany (2001) stated that if condom use were to become more prevalent among members of India’s heterosexual and homosexual community, the country’s yearly death toll due to complications from AIDS could be slashed by more than half due to far fewer rates of transmission.
Reference List
Ahmed, R, & Bhattacharya, S 2013, ‘Universal screening versus universal precautions in the context of preoperative screening for HIV, HBV, HCV in India’, Indian Journal Of Medical Microbiology, vol. 31, no. 3, pp. 219-225
Arora, P, Nagelkerke, N, Jha, P, & Graham, S 2012, ‘A Systematic Review and Meta-Analysis of Risk Factors for Sexual Transmission of HIV in India’, Plos ONE, vol. 7, no. 8, pp. 1-11.
Bachani, D, & Sogarwal, R 2010, ‘National Response to HIV/AIDS in India’, Indian Journal Of Community Medicine, vol. 35, no. 4, pp. 469-472.
Bharat, S, Mahapatra, B, Roy, S, & Saggurti, N 2013, ‘Are Female Sex Workers Able to Negotiate Condom Use with Male Clients? The Case of Mobile FSWs in Four High HIV Prevalence States of India’, Plos ONE, vol. 8, no. 6, pp. 1-8.
Bishnu, B, Bhaduri, S, Kumar, A, Click, E, Chadha, V, Satyanarayana, S, Nair, S, Gupta, D, Ahmed, Q, Sarkar, S, Paul, D, & Dewan, P 2013, ‘What Are the Reasons for Poor Uptake of HIV Testing among Patients with TB in an Eastern India District?’, Plos ONE, vol. 8, no. 3, pp. 1-8.
Chakravarti, P 2011, ‘The sex education debates: teaching ‘Life Style’ in West Bengal, India’, Sex Education, vol. 11, no. 4, pp. 389-400.
Eicher, A, Crofts, N, Benjamin, S, Deutschmann, P, & Rodger, A 2000, ‘A certain fate: spread of HIV among young injecting drug users in Manipur, North-East India’, AIDS Care, vol. 12, no. 4, p. 498.
Iqbal, H, Solomon, S, Murugavel, K, Solomon, S, & Balakrishnan, P 2012, ‘Evaluation of two indigenous rapid and two ELISA assays for the diagnosis of HIV infection India’, Indian Journal Of Medical Microbiology, vol. 30, no. 4, pp. 397-402.
Kohli, R, Tsui, S, Mehendale, S, & Tolley, E 2011, ‘Indian married men’s interest in microbicide use’, AIDS Care, vol. 23, no. 10, pp. 1344-1349.
Mitra, A, & Sarkar, D 2011, ‘Gender inequality and the spread of HIV-AIDS in India’, International Journal Of Social Economics, vol. 38, no. 6, pp. 557-572.
Mukherjee, K 2010, ‘Cost-effectiveness of Childbirth Strategies for Prevention of Mother-to-child Transmission of HIV Among Mothers Receiving Nevirapine in India’, Indian Journal Of Community Medicine, vol. 35, no. 1, pp. 29-33.
Raj, A, Saggurti, N, Cheng, D, Dasgupta, A, Bridden, C, Pradeshi, M, & Samet, J 2011, ‘Transactional sex risk and STI among HIV-infected female sex workers and HIV-infected male clients of FSWs in India’, AIDS Care, vol. 23, no. 11, pp. 1374-1381.
Ram, M, Gupte, N, Nayak, U, Kinikar, A, Khandave, M, Shankar, A, Sastry, J, Bollinger, R, & Gupta, A 2012, ‘Growth patterns among HIV-exposed infants receiving nevirapine prophylaxis in Pune, India’, BMC Infectious Diseases, vol. 12, no. 1, pp. 282-292 Rodrigues, R, Antony, J, Krishnamurthy, S, Shet, A, & De Costa, A 2013, ‘‘What Do I Know? Should I Participate?’ Considerations on Participation in HIV Related Research among HIV Infected Adults in Bangalore, South India’, Plos ONE, vol. 8, no. 2, pp. 1-8.
Saggurti, N, Mahapatra, B, Sabarwal, S, Ghosh, S, Johri, A, & Sandstrom, P 2012, ‘Male Out-Migration: A Factor for the Spread of HIV Infection among Married Men and Women in Rural India’, Plos ONE, vol. 7, no. 9, pp. 1-7.
Thappa, D, Singh, N, & Kaimal, S 2007, ‘Prostitution in India and its role in the spread of HIV infection’, Indian Journal Of Sexually Transmitted Diseases, vol. 28, no. 2, pp. 69-75.
Vaidya, N, & Jianhong, W 2011, ‘HIV epidemic in Far-Western Nepal: effect of seasonal labor migration to India’, BMC Public Health, vol. 11, no. 4, pp. 310-320.
Venkataramana, C, & Sarada, P 2001, ‘Extent and speed of spread of HIV infection in India through the commercial sex networks: a perspective’, Tropical Medicine & International Health, vol. 6, no. 12, pp. 1040-1061.
Venkatesh, K, Becker, J, Kumarasamy, N, Nakamura, Y, Mayer, K, Losina, E, Swaminathan, S, Flanigan, T, Walensky, R, & Freedberg, K 2013, ‘Clinical Impact and Cost-Effectiveness of Expanded Voluntary HIV Testing in India’, Plos ONE, vol. 8, no. 5, pp. 1-11.
Vicziany, M 2001, ‘HIV and AIDS in India: love, disease and technology transfer to the Kamasutra condom’, Contemporary South Asia, vol. 10, no. 1, p. 95.