ATLANTA, Georgia – For the world’s second most populated country, the Silver Jubilee of World AIDS Day (celebrated December 1) shone particularly brightly. India recently received a glowing review in the 2013 United Nations AIDS Global Report in two major statistical areas: infection rate and AIDS-related deaths.
The nation’s rate of new HIV infections dropped a staggering 57% from 2001 to 2011 (in comparison to neighboring Pakistan, for example, where rates increased eight-fold over the same span). According to UNAIDS, approximately 2.1 million Indians currently live with HIV, or 0.27% of the adult population. This is considered low for middle-income countries and is a stark contrast to the 4.9% infection rate of Sub-Saharan Africa.
The number of AIDS-related deaths in the nation also confirms that the AIDS epidemic is losing steam. Between 2007 and 2011, India experienced a 29% decline in this major category, an unequivocal win from a public health standpoint.
Since the nation’s first reported case of HIV in 1987, the government has attacked the epidemic with a three-pronged sword: information, health education and communication. Since India never suffered from the “AIDS Denialism” of some nations, such as South Africa, campaigns moved forward as knowledge accumulated, rather than stalling out. The Indian government’s current National AIDS Control Programme (NACP-IV) targets high-risk groups with preventative campaigns and aims to improve quality of care and treatment access. This NACP-IV, effective through 2017, hopes to “keep on keeping on” winning the AIDS numbers game.
India seemingly leads the charge to “get to zero” (the theme of this year’s World AIDS Day and the AIDS Campaign through 2015) in terms of AIDS morbidity and mortality. This, however, leaves the nation only two for three.
The “Getting to Zero” initiative also includes a provision for reducing discrimination against HIV positive persons to zero. Here, it seems, the nation falls short.
Traditional Indian culture creates an environment ripe for discrimination, while ignorance and fear contribute to a pervasive stigma against HIV-positive persons. Conservative, marriage-based values leave little room for consideration for the alternative lifestyles generally associated with HIV/AIDS. Further, India’s 28 states, many languages and hundreds of dialects pose a unique challenge to health educators, who have yet to fully inform the population at large of the science of HIV transmission. In fact, a 2009 National Aids Control Organization study indicated that approximately 72% of individuals surveyed believed that HIV could be transmitted by sharing food with someone.
Unfortunately, unfamiliarity with disease transmission and a fear of the unknown cannot account for the widespread mistreatment of HIV positive persons in the health care sector. It is not uncommon for doctors to refuse treatment following a patient’s status disclosure; many claim to suffer from other ailments to avoid rejection by their own physicians. Further issues include poor adherence to regulations providing for safe blood storage at blood banks and the unattainability of Anti-Retroviral Therapy, which costs approximately $48 and is out of reach for an estimated one million needy people.
The solution to India’s prejudice against HIV/AIDS now lies in the hands of the law ministry. First conceived in 2006, the bill would protect against discrimination based on HIV status in employment, healthcare, education, and other areas. India’s health ministry spent five years drafting the legislation, which has stalled yet again, much to the dismay of activists and non-profits. These equal rights mavericks took to the streets of the capital on World AIDS Day in hopes that the occasion would cause the world to glance their way and put pressure on decision makers to remember the campaign’s third zero.
– Casey Ernstes