HIV/AIDS in India World AIDS Day 2006 December 1 Tej Ram Jat IFP Alumni Cohort 3

Status of Epidemic 1 Case 1986 to 5.206 million 2005 HIV prevalence among adult population at 0.91 % 1,70,000 children below 15 are living with HIV (as per UNAIDS projections) 6 states as high prevalence, 3 states moderate prevalence and 14 states highly vulnerable States & 12 states are vulnerable states 111 districts are high prevalence districts with HIV prevalence more than 1% in ante-natal women and/or more than 5% in high risk groups India is second only to South Africa in absolute numbers

Changing face of Epidemic Movement from High risk groups to general people From urban to rural areas From High Prevalence states to all states

What we were told… AIDS is an incurable disease and leads to death AIDS is common among particular high risk groups like sex workers, drug users, truck drivers ( others…. not us) HIV infection spreads through unprotected sex with many partners (and having one sexual partner is safe) We were initially told that AIDS is a disease of foreigners and the Indian value system would not let the disease spread in the country Now we know that India has the second highest highest number of positive persons in the world

What was the response… IEC and BCC– School and University programmes, Newspaper Advertisements, Hoardings and bill boards : stationary and mobile, TV programmes…. Family Health Awareness Camps – STD control Condom promotion VCT Targeted Interventions (among CSWs, Truck Drivers, anti-Trafficking programmes) Blood safety Surveillance

Why did this not work? Denial, false morality and lack of openness….. That many Indians have sex with multiple partners and that same sex behaviour is common That commercial sex work is common That HIV infection could happen to any of us That young people should have sexuality education Delay in understanding the socio-economic basis of the infection Sluggish health system response

Where are we now ? Many of us may have the infection, others have friends who have the infection Many know of people who died after wasting away without any proper disease being established We know AIDS is commoner among urban, rural people, the poor, among women and young people We know HIV infection can take place among persons who have had only one sexual partner We know that AIDS is now a treatable condition We know a vaccine is still far away and so we have to co-exist with the virus.

New issues for consideration Poverty, economic vulnerability and HIV : Migration preparedness Gender discrimination, Violence and HIV : Couple Counselling HIV – Stigma and discrimination: Role of the media Living with HIV – Support, Care, Treatment Women and HIV: Multiple Vulnerabilities, Care-giving, Stigma, Blood-banking Holistic integrated approach vs narrow vertical programme ( with high external inputs)

The way forward …… Thinking beyond a ‘technological fix’- condoms, testing, ART, microbicide, vaccines Improving government's response in ‘high vulnerable’ as well as other states Addressing economic and social vulnerabilities – incorporating these into the response Focusing on women’s empowerment and gender equality – involving men as partners Providing leadership opportunities to the vulnerable and affected Protecting the rights of the vulnerable and affected Providing long term care, support and treatment: integrating social with medical support

Lets join HANDS..

Thank you