At an Aids support centre operated by Freedom Foundation, a private charity in Bangalore, the beautiful brown eyes of Rajni (not her real name), a young Indian mother, look into a bleak future. Married at 14, she became a widow at 20 when her husband, who ran a small business, died of Aids-related illnesses — and she tested positive for HIV.
As she watches her 12-year-old son, also HIV-positive, play in the courtyard, she speaks sadly of her healthy nine-year-old daughter, given to her sister so that she does not have to bear the stigma of the disease.
She speaks of a supportive extended family, but describes how the cost of her husband’s medical care forced her family to sell their home and condemned 24 relatives to poverty.
More than 5,1-million people in India are infected with HIV — 500 000 more than at the end of 2002. The country now has the second-highest number of cases in the world. The disease is already present in all 35 states and some experts expect that as many as 15-million people could have the virus by the end of this decade unless decisive action is taken.
By 2010, an estimated two million Indians will die of Aids if nothing is done to stop the impending epidemic. Unfortunately, the widespread ignorance and stigma associated with Aids hampers efforts to prevent the spread of the disease. Lack of education leaves some people believing that Aids can be contracted from a mosquito bite or from shaking hands with an infected person, and others not realising the dangers of indiscriminate and unprotected sexual activity.
Much of the publicity about Aids creates the impression that only marginalised elements of society — such as sex workers and drug abusers — are in danger of the disease. But Aids is spreading rapidly through India’s general population in both rural and urban areas: about 60% and 40% are infected respectively. One-third of HIV-positive people are women: more than 75% of Aids infections result from heterosexual intercourse, mostly between husband and wife.
The increase of Aids in women is particularly tragic because their lack of power and security means they can do little to protect themselves from infection by their husbands, who usually contract the disease through sexual activity outside of marriage. Their low status, and the stigma of Aids, makes them afraid to go to medical practitioners for help, and their poverty often puts treatment out of reach.
Population increase, illiteracy, the lack of information, stigma and discrimination, poverty, migration, the lack of openness about sex, and inadequate health expenditures are the main factors that fuel the Aids epidemic in India. They promote denial and fear.
But there are signs of hope. India’s new Prime Minister, Dr Manmohan Singh, is calling for social reform to fight gender and class inequalities that promote the spread of Aids. The government has initiated a surveillance system to test for HIV/Aids at 450 sites across the country.
India need not fight this battle alone. Preventing an Aids epidemic will require effective partnerships. In the Bellary district outside Bangalore, Karnataka, and in five other states, an example exists of partnership between these states, the central government, the United Nations and NGOs that has begun to reduce women’s vulnerability by raising awareness of their reproductive health and rights. It also seeks to empower them to negotiate sexual relations and to increase their access to reproductive health services.
The coordinated HIV/Aids response through capacity building and awareness (Charca) initiative, jointly financed by the UN and The Netherlands government, focuses on women and girls aged between 13 and 25. It will empower women through community-based organisations such as the Freedom Foundation in collaboration with female village officials.
The Charca project is one of the first district-wide interventions for young women in the general population. It is working towards creating an environment that fosters equality and ensures justice for women and girls, seeking to equip them to protect themselves against the virus and to realise their rights.
Aishwarya Rai, a former Miss World, is a popular Bollywood actor and served as a member of the jury at the Cannes Film FestivalÂ