10.31.2010

A Tough Case: India

Late Beginnings
AIDS in India did not hit until late 1986 - later than most other nations in Asia and the world. India's HIV case is an interesting one. The low prevalence rate (currently .3%) in India is misleading. Although it is a low prevalence rate when compared to many other nations, it is masked by the large number of inhabitants of the country. India is home to over a billion people and there are somewhere between 3 and 6 million people living with AIDS and so far over 300,000 have died as a result. India is the country with the second highest death rate from AIDS. Its a hidden, big problem.

ARV Access
Access to antiretroviral drugs and therapy used to be hard to come by in India. In 2005 there were only 25 ARV treatment centers in the nation, not a whole lot for a country that large. However, in 2009 that number grew to 217. Increasing the number of centers that provide ARVs for those who have AIDS encourages them to seek treatment. India, being so big, is hard and expensive to travel around, so by having more treatment centers all over the country, people are now more likely to be able to afford to visit the nearest clinic.

AIDS awareness banner
Once at the treatment centers, ARVs are free! ARVs used to have to be paid for in India, but in an effort to make access to medicine more easy, the government made prescriptions free. As a result of free ARVs and more treatment center locations, the number of people taking ARVs has risen from 24,000 to 233,000! In India's worst hit province, Andhra Pradesh, 10,000 HIV positive people are now receiving ARVs compared to a mere 200 three years ago! Free medicine and easy access is clearly working on decreasing the treatment gap! Still, however, there is a large number of people who are not receiving the treatment they need - in fact, less than 15% of those who needed ARVs in 2007 were getting them. Also, only 14% of mothers who had HIV in 2007 that were in need of ARVs to prevent transmission to their children were receiving the dugs. Although great progress has been made, there is clearly a lot more that needs to be done.

Importance of Prevention
Globally, it is estimated that for every person who begins HIV treatment, between 3 and 5 new people are infected with HIV. Prevention campaigns are crucial in India but difficult to implement. The problem with India being so big is that there are so many different languages spoken and so many religions and cultures that one nationwide prevention campaign cannot be effective enough. That is why province-wide prevention campaigns work much better because they can target the individualized communities within in state. With localized prevention methods, the local languages can be used so that the community can understand the information being given to them. 

Prevention campaigns must also begin to target at-risk populations to better combat the spread of the epidemic. Although at-risk populations account for most HIV cases, only 5% of funding for HIV prevention is allocated for those specific populations which is not cost-efficient or effective for slowing the progression of AIDS. 

Women who are part of a
 microbicide campaign in India
Prevention campaigns in India have been unique. For example, 11,000 condom vending machines were installed in public places such as restaurants, schools, hospitals, and gas stations. In another Indian province, health activists raised awareness of AIDS through kite flying which is popular before a certain festival. India also launched the 'Red Ribbon Express' - a train that travels throughout the country and stops to educate, treat, and counsel people with HIV/AIDS and to treat people with sexually transmitted infections. The response to the Red Ribbon Express has been positive, with 3.8 million people reached in the first 6 months of the 2009 journey. These are just a few of the many ways that India has become creative in its prevention techniques. 

Road Blocks
Several issues are either preventing HIV/AIDS education in India or causing stigmatization. HIV/AIDS is extremely stigmatized in India and as a result, many who are HIV positive face discrimination and harassment. People tend to keep their HIV status a secret whenever possible for fear that if they disclose it they will face harassment at work, denied medical treatment, or stigmatization in their community. One study found that 25% of HIV patients were refused medical treatment because of the fact that they were HIV positive!

Many people are also still very misinformed on the HIV/AIDS. In rural areas of the nation, only 77% of men and 50% of women have heard of HIV/AIDS! Many also still believe it can be spread through mosquitoes and in one province of the country, one study found that nearly 73% of the population believed that it could be transmitted through sharing food with an HIV positive individual. 

A Difficult Road Ahead
India has a huge HIV positive population despite its small prevalence rate. Although ARVs are free and treatment is easily accessible, far too much of the population still lacks treatment and too many people are still misinformed on how HIV/AIDS is transmitted. With the many languages spoken throughout the country, prevention campaigns have to be done at a community level. The stigma of HIV also needs to be broken inside the country because far too many individuals are still being harassed and mistreated because of being HIV positive. India has the right ideas for prevention and treatment and they have implemented many great programs so far, but unless the barriers of discrimination and misinformation are broken down, not much hope for progress can be had.

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